Wiki Global Coding/Antepartum Care

[MLH614]

Very new to OB coding. Global codes always include antepartum, delivery, and postpartum, correct?

So if a clinic only provides antepartum and postpartum care they shouldn't be billing global codes? They would bill E/M for 3 antepartum, 59425 for 1-3 antepartum, 59426 for 7+ antepartum, and 59430 for postpartum care right?

Any links or other resources appreciated

 

[nielynco]

Very new to OB coding. Global codes always include antepartum, delivery, and postpartum, correct?

So if a clinic only provides antepartum and postpartum care they shouldn't be billing global codes? They would bill E/M for 3 antepartum, 59425 for 1-3 antepartum, 59426 for 7+ antepartum, and 59430 for postpartum care right?

Any links or other resources appreciated

If a provider affiliated with the practice did the delivery, you bill globally despite the clinic provider only doing the care. If an unaffiliated provider did the delivery you have two options, but you will need to coordinate with the billing provider in scenario 1: 1) bill the global code but append modifier 55 and 56 and the delivering MD applies a modifier -54 (this is the hard way). The easy way is to bill for the antepartum care and postpartum care separately and the delivering MD bills using the delivery only code for the type of delivery.

 

[centralizedcoding]

When billing for a pt w/ less than 4 visits how are these to be billed? Anything special I should be doing?

Currently I will bill 1,2or3 visits individually w/ 99213 w/ Dx of Z34.00 or Z34.80-Supervision of normal & other pregnancy w/ and w/o modifiers and insurance tends to always deny bundled global. Is there a more preferred Dx, Modifier, anything I may be missing? Or do you have to fight w/ most insurances to get paid for them?
Thanks for any insight you can offer!

 

[colebk]

When billing for a pt w/ less than 4 visits how are these to be billed? Anything special I should be doing?

Currently I will bill 1,2or3 visits individually w/ 99213 w/ Dx of Z34.00 or Z34.80-Supervision of normal & other pregnancy w/ and w/o modifiers and insurance tends to always deny bundled global. Is there a more preferred Dx, Modifier, anything I may be missing? Or do you have to fight w/ most insurances to get paid for them?
Thanks for any insight you can offer!

I came here to ask the same question. Our largest payer fights us every time and it's so frustrating and time consuming. I questioned if a modifier would be an option to un-bundle it, but it doesn't sound like it.

 

[csperoni]

Correct coding is for < 4 antepartum visits to be coded individually. Carriers will definitely have an issue if the new ob bills global. They don't want to pay 1 physician for global, and another for care that would be included in global. Even if the new ob split bills, some carriers will initially deny. Same thing often happens when billing for the 4-6 antepartum or 7+ antepartum.
However, regardless of how the new ob billed, your clinician is entitled to receive payment for services provided. This should be appealed.

 

[colebk]

Correct coding is for < 4 antepartum visits to be coded individually. Carriers will definitely have an issue if the new ob bills global. They don't want to pay 1 physician for global, and another for care that would be included in global. Even if the new ob split bills, some carriers will initially deny. Same thing often happens when billing for the 4-6 antepartum or 7+ antepartum.
However, regardless of how the new ob billed, your clinician is entitled to receive payment for services provided. This should be appealed.

It's just so frustrating when BCBS itself is saying yep, that's correct... but we're going to deny it first. Thanks for your help!

 

[centralizedcoding]

I came here to ask the same question. Our largest payer fights us every time and it's so frustrating and time consuming. I questioned if a modifier would be an option to un-bundle it, but it doesn't sound like it.

It's extremely frustrating! I've been at this for almost 7 years and I have yet to make any headway. I was afraid it would be down to reconsideration and appeals which is time consuming and I find it hard to be able to juggle the volume of coding & fighting insurance over this kind of thing.

 

[centralizedcoding]

Correct coding is for < 4 antepartum visits to be coded individually. Carriers will definitely have an issue if the new ob bills global. They don't want to pay 1 physician for global, and another for care that would be included in global. Even if the new ob split bills, some carriers will initially deny. Same thing often happens when billing for the 4-6 antepartum or 7+ antepartum.
However, regardless of how the new ob billed, your clinician is entitled to receive payment for services provided. This should be appealed.

Do you have any advice on the appeal process for this such as particular records sent each time or anything? Currently I send itemized statement highlighting each DOS we provided, prenatal flowsheet also highlighted each visit and normally try to send any documentation that we have showing transfer of care into our office.

 

[colebk]

This may be a dumb question, but billing the NOB and placing them immediately into their global seems to be the issue. Our EMR allows us to suspend claims. Could we hold the first 3 visits and depending on whether pt returns for 4th or not, we could bill out accordingly ie either all 3 E/Ms or OBs. I know timeliness matters, but this is a huge issue for our practice at least. Any thoughts?

 

[Cmama12]

This may be a dumb question, but billing the NOB and placing them immediately into their global seems to be the issue. Our EMR allows us to suspend claims. Could we hold the first 3 visits and depending on whether pt returns for 4th or not, we could bill out accordingly ie either all 3 E/Ms or OBs. I know timeliness matters, but this is a huge issue for our practice at least. Any thoughts?

If I am understanding your question, in general, yes ,you would not bill until such time as the patient delivers, transfers care, moves, etc. You would use tracking codes 0501F, 0502F for the OB visits until then, after which you would determine what to bill based on all the information. That being said, there are sometimes payers, eg, Medicaid IL, that want each visit billed individually, so there, the 0502F has a fee attached and is billed out straight away after each visit.

 

[colebk]

I'm sorry... I think I have thoroughly confused myself (and others). To begin with, I've had very little support/guidance and I want to ensure I'm billing these correctly.
1. We bill E/M level 3 for +UPT as confirmation.
2. We bill 0500F for initial prenatal care... which I thought placed them into the global package.
3. Every next visit (unless non-pregnancy problem), we bill 0502F.

How does everyone else bill their pregnancies at the beginning?

 

[csperoni]

I'm sorry... I think I have thoroughly confused myself (and others). To begin with, I've had very little support/guidance and I want to ensure I'm billing these correctly.
1. We bill E/M level 3 for +UPT as confirmation.
2. We bill 0500F for initial prenatal care... which I thought placed them into the global package.
3. Every next visit (unless non-pregnancy problem), we bill 0502F.

How does everyone else bill their pregnancies at the beginning?

1) For my OB practice, they sometimes start the initial prenatal care and flowchart at the confirmation visit. IF NOT, we bill E&M at whatever the appropriate level is based on documentation.
2) For the initial prenatal, flowchart is started (whether at the confirmation visit as noted above or at a separate visit), so we use 0501F.
3) Every additional visit that is part of the global we use 0502F. Remember there may be care during the antepartum period that is not part of the global. In those situations, we bill E&M at whatever the appropriate level is based on documentation.

Keep in mind the above is ONLY for carriers that accept global maternity (most do). I can only think of 2 carriers that do not accept global maternity and want all antepartum visits, with the appropriate method of delivery only code, and postpartum all separately. For those, we bill each service as it occurs. We also set up the system so if we forget and enter 050#F or global maternity for one of those carriers, the system reminds us to correct.

If at any point, the patient transfers into or out of the practice, or changes insurance carriers, we must then split bill and do so after delivery.

 

[colebk]

Thank you so very much for taking so much time with me. Our largest payor (BC) is denying E/M levels for visits 1-3 because they think it's bundled, right? Tons of billers are dealing with the same issue. I guess my question is if we can bill the original level 3 E/M for confirmation like we always do bc it's not part of the global and then "suspend" 0500F for initial OB plus the next two 0502F OB visits for this payor only until patient either 1) returns for 4th 0502F so that we can bill the visits globally or they transfer care/change insurance/pregnancy ends/, etc. and we can go back to the beginning and bill the first 3 visits as appropriate E/Ms instead of trying to un-bundle them from the global package by never placing them in it to begin with? I feel like I can't get what I'm thinking from my brain into words. If you've hung around long enough, thanks for trying to listen and understand.

 

[csperoni]

Thank you so very much for taking so much time with me. Our largest payor (BC) is denying E/M levels for visits 1-3 because they think it's bundled, right? Tons of billers are dealing with the same issue. I guess my question is if we can bill the original level 3 E/M for confirmation like we always do bc it's not part of the global and then "suspend" 0500F for initial OB plus the next two 0502F OB visits for this payor only until patient either 1) returns for 4th 0502F so that we can bill the visits globally or they transfer care/change insurance/pregnancy ends/, etc. and we can go back to the beginning and bill the first 3 visits as appropriate E/Ms instead of trying to un-bundle them from the global package by never placing them in it to begin with? I feel like I can't get what I'm thinking from my brain into words. If you've hung around long enough, thanks for trying to listen and understand.

If you see the patient for confirmation, then 1-3 antepartum only (transfers care, TOP, insurance change, etc), I would not bill the 1-3 E&M visits until delivery or the pregnancy ends. Same if >3 using either 59425 or 59426.
You should not be billing those first 3 visits as E&M as they occur, unless the payor does not accept global maternity and has instructed to bill individually as they occur. It seems like maybe that is what you are doing, and the carrier is then correct in denying them.
In our system, we enter the 050#F codes as they occur. Those are not submitted to insurance. We keep a spreadsheet of EDD dates to ensure we don't miss anything. If we are 2 weeks past the EDD and realize the patient needs split bill (transfer, delivered out of state when traveling, TOP, etc), we correct the 050#F codes to E&M or 59425 or 59426 and submit to insurance.
As care is being provided, we always go under the assumption that the practice will be providing antepartum, delivery, and postpartum care. If for some reason we do not, THEN we split bill. Keep in mind many split bill claims (even if appropriately coded) will require further documentation to payor to explain what/why/how it was split.
If this does not better explain for you, then please try to elaborate your specific situation.

 

[colebk]

Thanks for the information! No, we are billing them out as noted above (E/M for COP, 0500F for initial, and 0502F for the rest). I think I'm just wrapped up in my own head about why these are being denied if we do have to bill E/Ms at the end if the codes are not submitted to insurance anyway... so it would seem there wouldn't be anything to "un-bundle".

Thank you - I know I'm being super annoying. I'm just trying to get a grasp on why this one payor is driving us bananas over the E/Ms for 1-3 visits stating it's part of the global.