Can we bill Technical E&Ms for OB pre and post natal visits??

boogie9483

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Hi Everyone,

Can we bill a technical E&M for pre and post natal visits that are part of a OB package? If so can you share the guidelines?

Thanks!
 

thomas7331

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I'm not sure what you mean exactly by a 'technical E&M'. If you mean a technical component, the answer would be no - the global maternity codes are designated in the fee schedules as physician service codes and the technical component concept does not apply. If you mean can you bill a facility fee for the use of the clinic (if the services are done in a hospital) that's a different question and you can probably bill that - global concepts usually do not apply to facility services - but you'd need to look to your payer guidelines and contracts to know for sure.
 

boogie9483

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Let me rephrase... How should the facility charge for antepartum and postpartum visits? If on the professional side I bill 59425 for 4-6 antepartum visits, how would the facility bill for this? Let's use medicaid as an example. Is there a code that would be inclusive of the 4-6 visits? Or do we have to send a separate technical charge each time the patient comes in? If so, what am I billing; Technical E&M? Where could I find that in writing?

Thanks!
:)
 

thomas7331

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If your payer is following an OPPS payment system, then yes, you'll bill the physician global charge just once for the multiple visits and the facility will bill a charge for each visit - most payers following OPPS will look for revenue code 510 with HCPCS code G0463 to represent the clinic charge for an E&M encounter. But you'd need to look at your individual payers' guidelines on this. Global concepts usually don't apply to facility charges, but individual payers may have specific guidelines on how they want this billed. For example, some payers don't recognize or pay revenue code 510, in which case they may allow the facility its payment for the multiple services under a different billing arrangement.
 

boogie9483

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If your payer is following an OPPS payment system, then yes, you'll bill the physician global charge just once for the multiple visits and the facility will bill a charge for each visit - most payers following OPPS will look for revenue code 510 with HCPCS code G0463 to represent the clinic charge for an E&M encounter. But you'd need to look at your individual payers' guidelines on this. Global concepts usually don't apply to facility charges, but individual payers may have specific guidelines on how they want this billed. For example, some payers don't recognize or pay revenue code 510, in which case they may allow the facility its payment for the multiple services under a different billing arrangement.

Is this in writing somewhere?
 

boogie9483

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