Wiki Global Issue

[gmitch02]

Good Morning,

I am having difficulty with what should be included in the global delivery. Patient presents to office and is having problems associated with fetal stress & preeclampsia so our physician places patient in observation, on the second day our physician admits the patient (again problems associated with the pregnancy) on third day patient delivers. How should this be coded per CPT codes.

First day: 99218
Seconday day: 99221
Third day: 59400

Should we bill for the OBS & Admit because this was above and beyond the normal pregnancy global?

Thank you,

 

[ajs]

Yes you bill for the services prior to delivery. These were due to a problem with the pregnancy, not normal routine care.

 

[AMBERRUIZ]

With this situation, most insurance carriers, will not reimburse you for admitting or observing the patient 24-48 hours prior to delivery. Even when the patient is admitted with a problem. Depending on edits within the health plans is wether or not they will reimburse you. You may get reimbursed for the observation but you will end up having to adjust off billing for the day before. You are not able to bill for admitting a patient the day before delivery even if you did not know the patient was going to deliver. Even though CPT states we can bill for anything outside of the normal routine pregnancy, the insurance companies say otherwise.
Hope this helps and if you have any questions, please feel free to email me.

 

[ajs]

With this situation, most insurance carriers, will not reimburse you for admitting or observing the patient 24-48 hours prior to delivery. Even when the patient is admitted with a problem. Depending on edits within the health plans is wether or not they will reimburse you. You may get reimbursed for the observation but you will end up having to adjust off billing for the day before. You are not able to bill for admitting a patient the day before delivery even if you did not know the patient was going to deliver. Even though CPT states we can bill for anything outside of the normal routine pregnancy, the insurance companies say otherwise.
Hope this helps and if you have any questions, please feel free to email me.

I have had many insurances reimburse for services prior to delivery, especially due to problems with the pregnancy. The only part we don't get is day of delivery and postpartum, unless other significant issues arise. You can fight insurance companies with excellent documentation and using the standards from ACOG and the AMA CPT book. That doesn't mean I always win, but I always try. Just have to keep taking it higher and don't accept denials until every avenue has been exhausted.