Wiki Billing global packages within single group

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debellis59

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When Dr. A provides all the antepartum and postpartum care, but Dr. Z delivers Dr. A's patient, and they are in the same practice and therefore under same Tax ID, is the billing submitted under Dr. A or Dr. Z? I've always coded the package under Dr. Z as he is the surgeon, but am being told by clinic manager that I should be billing under Dr. A.

She states that if audited, OB is "different" and that I should be billing under the doctor that attended the patient throughout the pregnancy ... and not the surgeon who delivered the baby.

Help. I would like some documentation that shows which way is right. All I find online is that the care needs to be billed globally, but not which provider would be correct to bill under.

And yes, I am going to work on getting my OBGYN certification later this year ... haven't yet received the study materials.
 
Can you clarify if patient was seen by both physicians on different dates during antepartum period since both physicians work in the same group practice and if she will continue to see both physicians during postpartum care at different dates?

Nidhi M., CPC
 
Typically they don't go back and forth between the physicians much, if ever. It's just that sometimes one physician will do the delivery and none of the other care ... no antepartum, no postpartum.

So, the question is ... which physician to bill under ... the one that does the ante and postpartum care or the one that does the delivery?
 
When this occurs where primary OB provides the antepartum/postpartum care and another physician from the same group delivers the baby, the global OB package should be billed under the primary doctor who provided the OB care.

Hope this helps.


Nidhi M, CPC
 
You can get this information from the medical policies and billing guidelines from the patient's insurance plan website. Patient's insurance plan will have more information on as how they would like to see the claim billed.

However, you can refer to AAPC healthcare Business Monthly August 2013 issue (From Antepartum to Postpartum, Get the CPT? OB Basics).


Thanks,

Nidhi M, CPC
 
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