Ob-Gyn Coding Alert

Question: If multiple providers render portions of maternity care for the same patient (for example, one physician treats the patient at the beginning of her ob care, but she develops complications and is referred to a specialist for the remainder of her care), how should we  ensure that duplicate services are not billed?

Florida Subscriber

Answer: The answer depends on whether the obstetrician and the specialist are seeing the patient for the same condition, which would be concurrent care, or the specialist is dealing only with the complication while the obstetrician is dealing only with routine antepartum care.  In most cases, the maternal fetal specialist sees her once or twice for the complication and sends her back to the obstetrician for the rest of the care. Later in the pregnancy, another complication arises, and she goes back to the maternal fetal specialist.
 
And while this may seem like concurrent care, it really is not because the physicians are different, the diagnosis codes being used are different, and the regular obstetrician will bill for the routine antepartum services only. This means that they are not duplicating services.
 
If this is the situation, you could make a case for the obstetrician still billing the global obstetric package if he goes on to deliver the baby and take care of the patient in the postpartum period because he is providing the routine antepartum care. When the patient goes to see the specialist, that physician will bill the individual E/M visit (99201-99215), not antepartum care, and will be reporting the complication as the diagnosis. Alternatively, you could make a case for splitting the global package and having the obstetrician just bill for the antepartum care alone using 59425 (Antepartum care only; 4-6 visits) or 59426 (... 7 or more visits) if he transfers care to the specialist for the rest of the pregnancy.