Master When to Start the Global OB Package
Avoid denials with confidence by knowing exactly when global care begins. With more new coders entering the ob-gyn field, it’s the perfect time to revisit one of the most common gray areas in obstetric coding: when to start the global ob package. If your provider diagnoses pregnancy during a routine annual exam, should that visit count toward global care? Let’s break it down, so you’re ready for every scenario. Rule of thumb: Don’t start counting antepartum visits toward the global ob package (codes 59400, 59510, 59610, 59618) until the next full visit. That initial discovery visit — no matter how important — is often not the right place to kick off global care. Scenario: Pregnancy Diagnosed During Annual Exam Annual wellness visits often lead to the first pregnancy diagnosis, which can throw off your coding unless you follow these steps. When a pregnancy is diagnosed (Z32.01) during an annual visit (99384-99386 for new patients or 99394-99396 for established), report the annual exam as usual. Be sure to link Z32.01 (Encounter for pregnancy test, result positive) only to the pregnancy test, such as 81025 (Urine pregnancy test, by visual color comparison methods), and not the evaluation and management (E/M) service. Do NOT start the ob record yet. Starting global care here may lead payers to include the whole visit under the global package, which means lost revenue. Tip: Always code based on what’s known at the visit’s end. If pregnancy is confirmed, use Z32.01, but don’t start using codes like Z34.- (Encounter for supervision of normal pregnancy) or Z33.1 (Pregnant state, incidental) until the ob-gyn formally begins supervising the pregnancy at a future visit. Scenario: Patient Already Knows They’re Pregnant If the patient comes in for their annual exam already aware they’re pregnant, consider these coding options: Once the ob record starts (typically at the next full visit), that visit kicks off the global ob package — covering up to 13 antepartum visits. Scenario: Other Complaints Lead to Pregnancy Discovery If a patient comes for their annual exam but has other complaints — and pregnancy is diagnosed in the process — you may be able to report a higher-level E/M (e.g., 99214 [… moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.]), if the documentation supports it. In that case, the visit wasn’t originally for pregnancy confirmation, and provider addressed other issues and confirmed pregnancy through a test like 81025. Then code Z32.01 supports the test, but you shouldn’t use it to start the ob package yet. Pregnancy Diagnosed at a Non-Annual, Unscheduled Visit Here’s how to approach walk-ins or symptom-driven appointments where pregnancy is diagnosed unexpectedly: Scenario 1: Patient presents with unrelated symptoms A patient presents with abdominal pain, cramping, or a missed period. These symptoms prompt a test that reveals pregnancy. You should: Scenario 2: Patient suspects pregnancy due to symptoms If the patient believes they might be pregnant and the ob-gyn initiates prenatal care during this visit (e.g., documents an ob history, performs an ultrasound, or begins supervision), global care starts now. If signs and symptoms point to pregnancy and the ob record begins, this visit counts toward the global ob package. Scenario 3: Patient already has a positive home pregnancy test If the patient comes in just for confirmation: Some practices don’t accept home pregnancy tests and require lab confirmation from a provider — always follow your internal policy and payer rules. Understand the Bottom Line for Ob-Gyn Coders Starting global ob care too early can cost your practice. Coders need to: Staying sharp on these scenarios helps protect revenue and ensures proper reporting — something every ob-gyn coder should feel confident about. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
