Wiki global maternity dilemma

[jebond123]

Can I bill globally for a patient who started her OB care with us at 19 weeks? She didn't know she was pregnant because she is nursing her infant. She has not seen another OB.
Insurance is commercial PPO thru Blue Shield of California.

 

[nielynco]

Can I bill globally for a patient who started her OB care with us at 19 weeks? She didn't know she was pregnant because she is nursing her infant. She has not seen another OB.
Insurance is commercial PPO thru Blue Shield of California.

Unless there are a set number of visits required by the payer to bill globally you may do so. Because she started late, it may be that the provider saw her more frequently in the beginning of the pregnancy so that eventually you had close to 13 visits before delivery. But remember that 13 visits is not written in stone. If you provided all of her care you should bill globally (unless told to do otherwise by the payer) and a modifier -52 should not be applied unless you only provided 3 or fewer antepartum visits before delivery (also not a written rule, but one that makes sense).

 

[jebond123]

Thank you