Wiki Global package

[Korbc]

Hello, I was just wondering what are some conditions or complications of pregnancy some of you are billing separately for? I see that you can bill some complications related to pregnancy such as hemorrhage, placenta previa, pre eclampsia, and severe hypermesis, along with conditions not related to pregnancy. Is billing out visits for pelvic and pain and increased discharge separately? These seem pregnancy related in my opinion and global but there's no certain determination to that? Also I know I see if there's problem visits that exceed 13 visits but would anyone still charge out for a problem visit of they transferred care and they arnt global so there's no way for them to exceed the 13 visits?
Thanks!

 

[nielynco]

Hello, I was just wondering what are some conditions or complications of pregnancy some of you are billing separately for? I see that you can bill some complications related to pregnancy such as hemorrhage, placenta previa, pre eclampsia, and severe hypermesis, along with conditions not related to pregnancy. Is billing out visits for pelvic and pain and increased discharge separately? These seem pregnancy related in my opinion and global but there's no certain determination to that? Also I know I see if there's problem visits that exceed 13 visits but would anyone still charge out for a problem visit of they transferred care and they arnt global so there's no way for them to exceed the 13 visits?
Thanks!

So here is the issue. CPT says you can bill for complications of pregnancy, and payers say they will only pay for them under certain circumstances. And then there is the issue of timely filing. I advise my clients to bill only those complications for which treatment was given on that date and well documented, and not to bill for complications simply addressed or talked about during a routine scheduled visit. In other words, the complication and the supporting documentation should show it was significant. And then you should bill for these at the time of the visit. You will most likely get a denial, but then you can appeal after delivery if the care exceeds 13 visits in total. If you wait until the end of the pregnancy to bill these visits, they will get denied for timely filing and using a modifier -22 on the delivery code (also an option) still requires a lot of paperwork proving the additional work above the global care expectations. But if they transfer out, you can still bill for the complicated visits even if you did not get to the magic 13 visits. But documentation is all important!