Clarification needed around Antepartum Care global


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I need clarification regarding billing in antepartum care. I want to make sure I am billing correctly. It is my understanding that the first visit, when pregnancy is confirmed is a regular E/M code billed out. When the patient returns for their history of OB and new or transfer OB exam is done, this is when the global starts. If both of these are done on the same day, would this count as 1 visit vs. them being done on 2 separate days? Also, these would not be initially billed out as E/Ms as they would be included in the antepartum/delivery coding. Or am I totally off on this.

For example, patient comes in for visit and pregnancy test is done which confirms pregnancy. I would bill a regular 99213. The patient returns in 3 days and sees the nurse to have the history of OB done. I would not bill for this. The patient then sees the provider who does the new OB visit. I would not bill an office visit for this either and would count it as 1st antepartum visit. If the patient is seen through delivery I would just bill the 59426 (assuming we do not do the delivery).

Another biller in my group indicates that you should bill all 3 of these visits as individual E/Ms. The antepartum package would be based on the number of subsequent visits. Their contention is that according to Medicaid guidelines the package doesn't start until after the 3rd visit. I don't read it that way. My understanding is that those visits would be billed as E/Ms if the patient doesn't come back after the 3rd encounter.

I am very confused. Please help!


Oak Park, IL
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You definitely should find out what your state's Medicaid guidelines are for billing OB care. In general, you should bill the visit confirming the pregnancy and subsequent visits are global and/or visits should be considered global if the antepartum record was initiated.
For my state, Medicaid does not accept any global ob billing, so each visit is billed separately and the delivery code is a delivery only CPT