Ob-Gyn Coding Alert

Question: Would you please explain -global-? Many of my co-workers feel that submitting the first visit where the diagnosis is now V22.0 or V22.1 (Normal pregnancy ...) is acceptable. Many carriers are remitting back.

Kentucky Subscriber

Answer: -Global- refers to global ob package. The global package includes all antepartum care once the ob-gyn or a member of the practice initiates the ob record. It also includes the admission to the hospital for delivery, the delivery, hospital inpatient postpartum visits and outpatient postpartum visits for up to six weeks for vaginal delivery and maybe a bit longer for cesarean (two visits instead of one). 
 
The only time you should not include the first visit in the global is if this visit is solely to diagnose pregnancy. In that case, if you know the patient is pregnant at the end of the visit, you should report V72.42 (Pregnancy examination or test, positive result), not the supervision-of-pregnancy codes. If the ob-gyn performs a history and physical at this visit or counseling regarding pregnancy, you cannot include that as a billable service. 
 
Keep in mind: The initiation of the ob record does not mean the physician has to be the one who sees her. It can be the certified nurse midwife or nurse practitioner who fills out the history forms and does the counseling -- all of which is included in the global package. The visit to diagnose pregnancy is going to be a low-level service in the absence of problems that the ob-gyn might need to evaluate first. 
  
Note: Make sure you know how to start the ob record by reviewing the July 2006 Ob-Gyn Coding Alert article -Wondering When to Start the Ob Record? Take This 6-Question Challenge.-