Wiki help! I/P hospital visits and global

Create Wiki
O

OBcoder2017

Guest
Messages
81
Location
Cape Girardeau, Missouri
Best answers
0
Are inpatient hospital visits for pregnancy complications payable outside of the global package? In other words, can I bill for complication visits at hospital and still bill the global delivery at the end without breaking the global package? I've taken an AAPC course that stated that we absolutely can bill for excluded antenatal care w/o breaking global. Can someone please help here. I've struggled with this for quite some time and fight for this based on coursework I've taken through AAPC.
 
I believe you can. As long as the admission did not result in the delivery, you can bill inpatient changes. They are not included in the global package.
 
Our Medicaid Biller says we cannot bill them because they will break global. The office I am now working in had not ever billed hospital visits for non routine complications until I came. I am still an apprentice and just wasn't sure enough of myself to push this issue and wanted confirmation. When you read Medicaid guidelines it quite frankly is unclear at best when it comes to this question. Their guidelines tend to lead you to believe that anything about the pregnancy is global. We billed several and she says that just because they pay doesn't mean it is correct. I called Medicaid and they stated they would pay but our biller called them back and then told us they said they wouldn't. It is a bit of a circus. I want to step up with the knowledge that I am right but I want to be sure. Everything I read supports the billing of non routine complications for OB in the office or hospital. I am right now just focusing on trying to get the non routine complications in the hospital paid. I just thought it was possible that Medicaid wasn't following those rules. Our biller calls Medicaid about every question and I hesitate to contact them also. It just seems like that could cause problems to be asking so many questions from the same office. I'm just not sure she is interpreting their answers with a coders ear.
 
Last edited:
yes. You can bill these visits seperately. I work for a hospital based clinic. We do this on a regular basis and get paid as such. You can bill admit, sub care, and d\C visits for any type of complication visit. We also bill ED visits because our OB patients are seen on labor and delivery not in the emergency room.
 
You are right, you can bill the complication in the hospital. Extra work is being done due to a complication during pregnancy; global is billed at delivery but the extra work is beyond the global care. You can bill the visits or admission for complications if they are in the hospital until day of delivery, at the day of delivery is when the global hospital care begins.
 
You can bill out the hospital visit however if the patient delivers during that stay any services within the 24 hr period before delivery is included in the global package.
 
Okay stay with me on this...I've almost got it. So you agree that I can bill the hospital non-routine complication visits and still bill the global routine ob delivery code at the end? Should I bill the hospital visits as I go or wait until after the global delivery is paid? For example, after billing two different hospital stays for preterm labor, I would bill the global 59400 and still expect to be paid? My Medicaid biller has taken notes from their Education dept and they state that if billing hospital visits we cannot bill the global OB delivery and would have to bill individual office visits which does not result in as much reimbursement as the global.
 
Last edited:
Every state has its own mandates, but I haven't heard of any state refusing to pay for complications for hospital visits then refuse to pay the global delivery. Per the CPT book, global services are for normal complications and deliveries. In Texas, we bill for every visit as our Medicaid program pays fee for service. It sounds like you bill global at time of delivery; therefore, bill your hospital visits as they occur so you don't miss filing deadline, most are 95 days, then bill your global at delivery. If your Medicaid person disagrees, call your local office and ask for the guidelines in writing, you can use these to determine what needs to occur, or use for appeal.
 
You must log in or register to reply here.
Top