Wiki OB Care Package

[bessie_199@yahoo.com]

We are trying to figure out the appropriate time to bill for a global delivery.

Some of us bill globally as long as the patient has had the same insurance and been with the same provider throughout the entire pregnancy.

But some only bill out global if the patient has at least 13 visits with the same provider, same insurance. If not, then she will bill out the appropriate antepartum code (based on # of visits) and delivery/postpartum care code.

We have found some conflicting information regarding this and are unsure the proper way this should be done.

What is the requirement to bill global? Does the patient have to be seen by the same practice with the same insurance and have a minimum of 13 visits or is it enough that she was seen at the same practice with same insurance for entire pregnancy?

Please let us know your thoughts! Thank you!

 

[nielynco]

We are trying to figure out the appropriate time to bill for a global delivery.

Some of us bill globally as long as the patient has had the same insurance and been with the same provider throughout the entire pregnancy.

But some only bill out global if the patient has at least 13 visits with the same provider, same insurance. If not, then she will bill out the appropriate antepartum code (based on # of visits) and delivery/postpartum care code.

We have found some conflicting information regarding this and are unsure the proper way this should be done.

What is the requirement to bill global? Does the patient have to be seen by the same practice with the same insurance and have a minimum of 13 visits or is it enough that she was seen at the same practice with same insurance for entire pregnancy?

Please let us know your thoughts! Thank you!

No, there is no minimum and the exact number of visits has never been specified. CPT has used the recommendations that were formulated back in 1930 to help control preeclampsia: that is on visit a month from week 4-28, once every 2 weeks from week 29-36 and weekly at 36 weeks until delivery. Depending on when the mother began prenatal care and when she delivered, the average number of visits for this formula would get you 12-13 visits for the global package. But as we know a typical pregnancy may not be the norm. The deciding factor is therefore did a single provider provide all of the care to this patient? If so, no matter how many visits, you bill globally unless otherwise instructed by the payer. ACOG has suggested that if the number of total visits drops to 6 or less, you should consider adding a modifier -52 to the global code.

 

[bessie_199@yahoo.com]

No, there is no minimum and the exact number of visits has never been specified. CPT has used the recommendations that were formulated back in 1930 to help control preeclampsia: that is on visit a month from week 4-28, once every 2 weeks from week 29-36 and weekly at 36 weeks until delivery. Depending on when the mother began prenatal care and when she delivered, the average number of visits for this formula would get you 12-13 visits for the global package. But as we know a typical pregnancy may not be the norm. The deciding factor is therefore did a single provider provide all of the care to this patient? If so, no matter how many visits, you bill globally unless otherwise instructed by the payer. ACOG has suggested that if the number of total visits drops to 6 or less, you should consider adding a modifier -52 to the global code.

Thank you for the feedback!