Wiki Do you have to global bill deliveries?

[czcely]

Do you have to global bill deliveries? Or can a doc bill out each visit seperatly, and charge just for delivery? We have a clinic that states they can choose which way they want. I'm trying to find documentation to show that global billing (to commercial & self pay) IS the correct way to bill. Does anyone have any suggestions?
Thank you!!

 

[emagel@aqreva.com]

antepartum

I would suggest using antepartum care codes for the prenatal care visits. You can bill the antepartum seperate from the delivery if necessary but if it is the same physician providing the antepartum, delivery and postpartum care a global code is best.

 

[ajs]

Do you have to global bill deliveries? Or can a doc bill out each visit seperatly, and charge just for delivery? We have a clinic that states they can choose which way they want. I'm trying to find documentation to show that global billing (to commercial & self pay) IS the correct way to bill. Does anyone have any suggestions?
Thank you!!

If you separate the antepartum care, and postpartum care, from the delivery you are unbundling, this is not correct coding unless those are the only services that were provided.

The only situations where unbundling may be appropriate are; when different providers do the antepartum care, postpartum care and/or delivery, when there is a change in insurance mid-pregnancy, or when the patient transfers care mid-pregnancy.

Some state Medicaid programs have specific rules that do require split billing so for those programs you would follow their guidelines.

Most commercial insurance payers will require that you follow the global billing guidelines. For self-pay I would still use correct coding guidleines.

At the beginning of the Maternity Care and Delivery section in CPT the instruction states:
"The services normally provided in uncomplicated maternity cases include antepartum care, delivery and postpartum care."