Ob-Gyn Coding Alert

Question: I thought I read somewhere that when a patient is seen at your practice and is a transfer of care from another country you can still bill the global OB if they have 7 or more OB visits, but I can’t find it anywhere. Our patient was a transfer from Ecuador at 26 weeks, and we saw her for 7 visits. I want to bill the global ob package (59400), but my manager doesn’t think we can and wants something in writing prior to billing. What do you think?

Pennsylvania Subscriber

Answer: This has more to do with the payer than the care in many cases. Most experts recommend you bill globally (such as, 59400, Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/ or forceps) and postpartum care) given the 7 visits if the same payer was not responsible for the previous care.

You also have the option of adding a modifier 52 (Reduced services) to the global code as it was designed for 13 visits, not 7 (if you look at the frequency in the CPT^® definition of care).