Wiki First OB visit and problem visit on the same day

[ksaum]

How would you code an initial OB visit that also addressed 2 chronic conditions and has medication management. Typically we bill global for OB so I would bundle the OB portion with the rest of her visits, but the provider spent time addressing chronic conditions. Would you bill an E/M for the problem visit portion? The patient has Federal Blue Cross Blue Shield insurance. Thanks!

 

[csperoni]

It sounds like you provided global maternity care AND services excluded from global maternity on the same day. I suggest billing an E&M to the carrier leveled only by the non-maternity services with the problem diagnoses addressed. For example, don't count prescribing prenatal vitamins. The E&M should get a -24 modifier to show the carrier it is outside the global package.

 

[nielynco]

It sounds like you provided global maternity care AND services excluded from global maternity on the same day. I suggest billing an E&M to the carrier leveled only by the non-maternity services with the problem diagnoses addressed. For example, don't count prescribing prenatal vitamins. The E&M should get a -24 modifier to show the carrier it is outside the global package.

Sorry but the modifier -24 can only be billed after delivery (the modifier applies to unrelated services in the postop period). In this case she should bill just an E/M (no modifier), and I would strongly suggest/hope that the provider documented that these conditions were not complicating the pregnancy so the Z code could be reported instead of a code from Chapter 15 which would probably result in a denial. Good documentation will support these services at this first ob visit and any denial should be appealed.

 

[csperoni]

Sorry but the modifier -24 can only be billed after delivery (the modifier applies to unrelated services in the postop period). In this case she should bill just an E/M (no modifier), and I would strongly suggest/hope that the provider documented that these conditions were not complicating the pregnancy so the Z code could be reported instead of a code from Chapter 15 which would probably result in a denial. Good documentation will support these services at this first ob visit and any denial should be appealed.

Very interesting. I am getting deeper into some of the nuances of global maternity and attended a webinar just yesterday. Part of the presentation included the advice about using -24 for antepartum visits that are not part of global maternity which is why I even thought to add that in my original reply. I certainly trust your knowledge over the knowledge of last night's presenter! Thank you for the correction.

 

[tvaughn]

Very interesting. I am getting deeper into some of the nuances of global maternity and attended a webinar just yesterday. Part of the presentation included the advice about using -24 for antepartum visits that are not part of global maternity which is why I even thought to add that in my original reply. I certainly trust your knowledge over the knowledge of last night's presenter! Thank you for the correction.

Can you share which webinar you attended? I would love more knowledge on this specialty. I'm questioning if I can bill symptoms not related to pregnancy along with the initial OB visit.

 

[csperoni]

Can you share which webinar you attended? I would love more knowledge on this specialty. I'm questioning if I can bill symptoms not related to pregnancy along with the initial OB visit.

It was a local chapter meeting. I don't even recall 2 1/2 months later which chapter it was. I often will spend some time going through all the chapters looking for virtual meetings that relate to what I would like additional experience in.