The global obstetric (OB) code should be billed whenever one practitioner or practitioners of the same group provide all components of the patient’s obstetrical care, including; 4 or more antepartum visits, delivery, and postpartum care. The number of antepartum visits may vary from patient to patient, however, if global OB care (more than 3 antepartum visits, delivery, and postpartum care) is provided, ALL pregnancy-related visits (excluding inpatient hospital visits for complications of pregnancy) should be billed under the global OB code. Individual E/M codes should NOT be billed to report pregnancy-related E/M visits.
4-6 antepartum visits, delivery and postpartum care – Bill the appropriate global surgery code with the 52 modifier appended to indicate reduced services.
15 or more, medically necessary, antepartum visits (office or outpatient hospital)– Bill the appropriate OB global code and append the 22 modifier to indicate increased services. Individual E/M codes should NOT be billed for the excess office visits. Attach documentation(such as progress notes and/or the antepartum flow sheet) that clearly describes the medical necessity for each of the additional visits.. When documentation supports the medical necessity of the additional visits, IME will reimburse an additional $55.44, for each additional visit.
Inpatient hospital visits for complications of pregnancy may be billed using the appropriate level E/M code. The 25 modifier must be appended to the inpatient hospital E/M code.
Normal antepartum care, complicated delivery and postpartum care – Bill the appropriate OB global code and append the 22 modifier to indicate increased services. Attach documentation that clearly describes the increased service.
Antepartum, delivery and postpartum care for multiple gestations – Bill the appropriate OB global code (determined by the method of delivery of baby A), for 1 unit, and append the 22 modifier. The diagnosis should indicate that there were multiple live births. Attach documentation that describes the method of delivery (vaginal or C-section) for each baby.
Antepartum, assisted in delivery and postpartum care – Bill the appropriate OB global code and append the AS (non-physician providers) or 80 (physician providers) modifier as appropriate.
For billing purposes, the obstetric (OB) period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum period (56 days after vaginal delivery and 90 days after C-section).
Services rendered during the global period of another service are often overlooked. ‘Typical’ prenatal and postpartum visits are a part of the global delivery package. Problems not related to pregnancy, such as yeast infections, vaginitis, and sexually transmitted diseases (STDs), are not part of the global delivery package. Problems not related to pregnancy may be billed separately at the time of service or treatment.
‘Antepartum care only codes’ should be billed when the practitioner or practitioners of the same group, will not be performing all 3 components of global OB care (more than 3 antepartum visits, delivery, and postpartum care). Only one antepartum care code is allowed to be billed per pregnancy.
<3 antepartum visits are performed – bill appropriate E/M codes for the visits
4-6 antepartum visits – Bill 59425
7-14 antepartum visits – Bill 59426
More than 14 antepartum visits due to complications of pregnancy – Bill 59426 and append the 22 modifier to indicated increased services. Attach documentation (such as progress notes and/or the antepartum flow sheet) that clearly describes the medical necessity for each of the additional visits. When documentation supports the medical necessity of the additional visits, IME will reimburse an additional $55.44, for each additional visit.
Delivery begins on the date of initial hospitalization for delivery and extends through the date in which the member is released from the hospital. Hospital care, related to the delivery, is considered part of the delivery charge and is NOT considered part of postpartum care. If a C-section is performed, the reimbursement for the delivery only charge includes payment for the surgical procedure as well as the post-surgical care.
Vaginal delivery only – bill 59409
C-section delivery only – bill 59514
VBAC delivery only – bill 59612
C-section after attempted VBAC delivery only – bill 59620
Delivery of multiples – bill appropriate delivery code (determined by the method of delivery of baby A), for 1 unit, and append 22 modifier. Attach documentation showing the method of delivery for each baby.
Complicated delivery – bill appropriate delivery code and append the 22 modifier. Attach documentation describing delivery complications.
Postpartum care begins after the patient is discharged from the hospital stay for delivery and extends throughout the postpartum period (56 days for vaginal delivery and 90 days for cesarean delivery).
Postpartum care only – bill 59430
When a provider performs the delivery and postpartum care and did NOT perform the antepartum care, the appropriate delivery and postpartum code should be billed.
Vaginal delivery including postpartum – bill 59410
C-section delivery including postpartum care – bill 59515
Vaginal birth after cesarean delivery (VBAC) including postpartum care – bill 59614
C-section after attempted VBAC including postpartum care – bill 59622
