OB/GYN billing and coding always has been a challenge for most of billers and coders due to the global claims, widely varying coverage terms, and multiple tests performed at numerous facilities. Apart from this, many OB/GYN practitioners lack the billing support provided to large hospitals. As Pregnancy coverage includes inpatient and outpatient services, billers are not aware how to split between them.
Accurate OB/GYN billing requires a clear understanding of the criterion that determines the ‘medical necessity’ to code for the various levels of ground and air ambulance services used. Most billers are not aware of pregnancy coverage and various billing updates to an existing insurance plan. Most healthcare organization loses money as they overlook separately billable services rendered during the global period. In this article, we focussed on accurately billing global obstetrical package which will help you to reduce claim denials.
Before we proceed with billing the global obstetrical package, let's understand what includes the global obstetrical package. As defined by the American Medical Association (AMA), ‘the total obstetric package includes the provision of antepartum care, delivery, and postpartum care.’ When the Same Group Physician and/or Other Health Care Professional provides all components of the OB package, report the global OB package code.
The Current Procedural Terminology (CPT®) book identifies the global OB codes as: 59400, 59510, 59610, and 59618.
Separate reimbursements for services provided during the pregnancy that are included in the global obstetrical package for uncomplicated maternity cases are not allowed. The provider can only bill for the global obstetrical delivery if the same physician began routine antepartum care prior to the 28th week of gestation and continued care through the delivery and postpartum period, the physician must bill the appropriate code for total obstetrical care.
Evaluation and Management services and postpartum care billed for a date of service within a 42-day time frame will bundle into the global delivery service when billed by the same provider performing the delivery service, except when the E&M is unrelated to the obstetrical care or is related to a maternity complication.
Evaluation and Management services and postpartum care billed for a date of service within a 42-day time frame will bundle into the global delivery service when billed by the same provider performing the delivery service, except when the E&M is unrelated to the obstetrical care or is related to a maternity complication.
It is not appropriate for a single provider to bill more than one 59425 or 59426 in any combination during the antepartum period. If more than one of the Antepartum Care codes is billed by the same provider in a 240-day period, the subsequent billed codes will be denied.
Delivery Only (59409, 59514, 59612, 59620) Per the CPT book, ‘Delivery services include admission to the hospital, the admission history and physical examination, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery.’
When more than one provider group renders a portion of the antepartum care to a pregnant patient, it is inappropriate for the delivering physician to bill with a global obstetrical delivery code. The provider can only bill for the global obstetrical delivery if the same physician began routine antepartum care prior to the 28th week of gestation and continued care through the delivery and postpartum period.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. We referred various payer reimbursement policies and shared detailed information on billing global obstetrical package. You can refer payer specific billing and coding guidelines for accurate insurance coverage for the global obstetrical package.
You can refer our OB/GYN billing services to reduce claim denials and to receive accurate insurance collections. To know more about our OB/GYN billing and coding services, email us at: info@medicalbillersandcoders.com or call us: 888-357-3226.
