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Accurately Billing Global Obstetrical Package to Reduce Claim Denials


Article-Accurately-Billing-Global-Obstetrical-Package-to-Reduce-Claim-Denials

Challenges of OB/GYN Billing

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.

Billing Global Obstetrical Package

Defining the Global Obstetrical Package

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.

  • Antepartum care refers to the serious routine, regular obstetrical visits that are spread out during the 40 weeks of a typical pregnancy. These visits include performing a prenatal history and physical exam of the mother, identifying all medical factors that could affect the health of the baby, and the difficulty of the delivery. This phase of care also includes all the routine, regularly performed tests to monitor the development of the baby.
  • Delivery services include the mother’s admission to the hospital for birthing, the admission history and physical exam, management of labor, and either vaginal or cesarean delivery of the baby. The global package covers an uncomplicated delivery, so any significant complications of labor and delivery are separately billable if supported by appropriate documentation.
  • Postpartum care covers outpatient visits for a period of six weeks following delivery, during which the provider manages the acute effects of labor and delivery in the mother while also monitoring her general postpartum health.

Contents of Global Obstetrical Package

The Current Procedural Terminology (CPT®) book identifies the global OB codes as: 59400, 59510, 59610, and 59618.

Services Included in the Global OB Package

  • All routine prenatal visits until delivery (approximately 13 for uncomplicated cases)
  • Initial and subsequent history and physical exams
  • Recording of weight, blood pressures, and fetal heart tones
  • Routine chemical urinalysis (CPT codes 81000 and 81002)
  • Admission to the hospital including history and physical
  • Inpatient Evaluation and Management (E/M) service provided within 24 hours of delivery
  • Management of uncomplicated labor
  • Vaginal or cesarean section delivery (limited to single gestation)
  • Delivery of placenta
  • Administration/induction of intravenous oxytocin
  • Insertion of a cervical dilator on the same date as delivery
  • Repair of first- or second-degree lacerations
  • A simple removal of cerclage (not under anesthesia)
  • Uncomplicated inpatient visits following delivery
  • Routine outpatient E/M services provided within 6 weeks of delivery
  • Postpartum care only
  • Educational services e.g., breastfeeding, lactation, and basic newborn care

Services Excluded from the Global OB Package

  • Initial E/M to diagnose pregnancy if the antepartum record is not initiated at this confirmatory visit. This confirmatory visit would be supported in conjunction with the use of ICD-10-CM diagnosis code Z32.01.
  • Laboratory tests (excluding routine chemical urinalysis)
  • Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828).
  • Amniocentesis, any method
  • Amnioinfusion
  • Chorionic villus sampling (CVS)
  • Fetal contraction stress test
  • Fetal non-stress test
  • External cephalic version
  • Insertion of cervical dilator more than 24 hours before delivery
  • E/M services for the management of conditions unrelated to the pregnancy (e.g., bronchitis, asthma, urinary tract infection) during antepartum or postpartum care; the diagnosis should support these services.
  • Additional E/M visits for complications or high-risk monitoring resulting in greater than the typical 13 antepartum visits;
  • Inpatient E/M services provided more than 24 hours before delivery.
  • Critical care services that are unrelated to the specific anatomic injury or general surgical procedure performed, within a global surgical period.
  • Management of surgical problems arising during pregnancy (e.g., appendicitis, ruptured uterus, cholecystectomy)

Global Obstetrical Package (59400, 59510, 59610, 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.

Global Obstetrical Delivery Post-Operative Care (59410, 59515, 59614, 59622)

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.

Global Obstetrical Delivery Post-Operative Care (59410, 59515, 59614, 59622)

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.

Antepartum Care (59425 and 59426)

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.’

Antepartum Care by Different Provider Groups

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.

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