Wiki Inpatient Admission 4 Weeks Prior to Delivery

[acooper1]

We have a patient who was admitted to the hospital for management of her pregnancy, due to loss of a twin in-utero, 4 weeks before she delivered. The provider sent me the inpatient daily visit charges to 'bill out', but I am certain this still falls under the Global OB package, as we have seen her for the duration of her pregnancy (so we billed for global delivery code, as well). Am I correct in my thinking that the Inpatient services are not billable to the payer? They are bundled in with the Global OB Package?

 

[smoore123]

Good Morning,

This would not be considered routine OB care and I would submit these services to the payer. Make sure the documentation supports the diagnosis for the admission to convey this to the payer. I would also recommend reviewing the payers policy many payers have policies in place on how to bill for OB services that may differ from payer to payer.

Here is an example of Harvard Pilgrims policy to give you an idea:

If there are additional antepartum E&M visits for complications the claim for the global obstetrical care may be given individual consideration. Harvard Pilgrim will require the use of modifier 22 when billing the global obstetrical codes, which indicates services are over and above the typical care (typically 14 visits) and the submission of all medical documentation (such as progress notes and/or the antepartum flow sheet) the additional visits should be documented in the member’s medical record.

If the medical documentation doesn’t support additional visits due to complications no additional reimbursement will be applied.

 

[acooper1]

Thank you, Stephanie. That is helpful - I was going by the ACOG recommendation. I will check the individual payer policy for this patient. She will, however, need to get the documentation from the hospital scanned in to the system, particularly if the payers will want this, retrospectively.

Thanks so much!