RABBIT2020
Networker
This is a group practice – MFM and OBgyn
MFM specialist at ultrasound location with unique tax id.
Office obgyn is billing at another location with a unique tax id.
1ST ULTRASOUND SITE
Mfm specialist interprets BPP
BPP score 6/8 -2 for no breathing
Recommends NST
2ND OFFICE FOR NST
obgyn Performs NST
NST documented format on progress note
time documented as 40 mins for E/M (I am being convinced to code both the NST and the E/M service. Rationale being it is a problem visit. Howver,I feel it is an ob related and not billable separately. Also with the new outpatient guidelines "The AMA/CPT guidelines are very clear that any time spent on a separately billable service (ultrasound, procedure, etc.), cannot be included in the time used to assign an E/M service level based on time.")
3RD OFFICE VISIT ROUTINE OB
Same OBgyn who performs NST
documents a 2nd progress note for routine OB visit E/M time as 20 mins
In this scenario that occurs on the same date of service:
Given that the BPP is interpreted and patient is sent for the NST is it correct to bill (cpt 99215) 40 minutes E/M with the (cpt 59025) NST service. The note does not specify that x minutes were for the nst and y minutes were for E/M. It is just total time.
In addition, the routine ob visit gets a 20 minutes time which is not billed because it is of the global package
This below is the general antepartum guidelines:
The following services usually occur during antepartum care, but are not inclusive to the global OB package, and may be reported separately:
MFM specialist at ultrasound location with unique tax id.
Office obgyn is billing at another location with a unique tax id.
1ST ULTRASOUND SITE
Mfm specialist interprets BPP
BPP score 6/8 -2 for no breathing
Recommends NST
2ND OFFICE FOR NST
obgyn Performs NST
NST documented format on progress note
time documented as 40 mins for E/M (I am being convinced to code both the NST and the E/M service. Rationale being it is a problem visit. Howver,I feel it is an ob related and not billable separately. Also with the new outpatient guidelines "The AMA/CPT guidelines are very clear that any time spent on a separately billable service (ultrasound, procedure, etc.), cannot be included in the time used to assign an E/M service level based on time.")
3RD OFFICE VISIT ROUTINE OB
Same OBgyn who performs NST
documents a 2nd progress note for routine OB visit E/M time as 20 mins
In this scenario that occurs on the same date of service:
Given that the BPP is interpreted and patient is sent for the NST is it correct to bill (cpt 99215) 40 minutes E/M with the (cpt 59025) NST service. The note does not specify that x minutes were for the nst and y minutes were for E/M. It is just total time.
In addition, the routine ob visit gets a 20 minutes time which is not billed because it is of the global package
This below is the general antepartum guidelines:
The following services usually occur during antepartum care, but are not inclusive to the global OB package, and may be reported separately:
- Complications of the pregnancy
- Evaluation and management (E/M) services for problems unrelated to the pregnancy
- Lab tests performed outside of routine chemical urinalysis, including venipuncture
- Surgical complications or other problems related to the pregnancy
- Amniocentesis
- Chronic villous sampling
- Cordocentesis
- Fetal stress testing
- Fetal non-stress testing
- OB ultrasounds (limited or complete)
- Fetal biophysical profile
- Fetal electrocardiography
- RH immune globulin administration