Wiki Global without post partum

[amybuxton]

Hi all! I have a practice that is billing maternity global care, however at times the client does not come in for her 6 week postpartum visit. The provider is stating they still bill global in these cases. We feel this is not appropriate as the full package was not provided without the postpartum visit. What are your thoughts? Does anyone have any citations/documentation anywhere with guidance in this particular situation? Thank you all!

 

[csperoni]

If the office did not provide any postpartum services, I would not bill global. I would bill antepartum and delivery only.
If the office provided at least some postpartum services (hospital rounding and discharge, for example), I would be OK billing global. As noted by ACOG, the postpartum period begins immediately after delivery. While I do not bill maternity care, for my colleagues that do, the global is billed when the patient is discharged from hospital.

Billing for Care after the Initial Outpatient Postpartum Visit: The Fourth Trimester

The American Rescue Plan Act, signed into law on March 11, 2021, makes available a new pathway states can use to extend Medicaid coverage for pregnant people to one year postpartum.

www.acog.org

https://www.aapc.com/blog/25857-from-antepartum-to-postpartum-get-the-cpt-ob-basics/

 

[Lera]

I agree with you. Codes exists to bill antepartum and delivery only for a reason. So if postpartum care has not been performed global maternity package should not be billed. Instead appropriate CPTs for number of antepartum visits and type of delivery should be reported.

 

[kwilliams0507]

Many of our payers in this area still state that we are able to bill for global even when the patient does not come back for the actual pp visit. They do not expect our providers to wait 6 weeks to bill for services, after determining if the patient will return to the office setting.
Here is information from the UHC Obstetrical Policy.

Q: Should a postpartum visit be provided within the ACOG standard six-week period? A: The postpartum period includes routine office or outpatient postpartum visit(s) usually, but not necessarily, performed 6 weeks following delivery. If a physician routinely performs more than one postpartum outpatient visit in an uncomplicated case, the extra visit(s) is not billed separately. When a postpartum visit is scheduled, but the patient does not keep the appointment, the physician's documentation should reflect that the patient did not appear for the scheduled postpartum visit. This visit does not have to be refunded if a global OB code was previously submitted. If a patient returns to the office well after their scheduled postpartum visit (e.g., 6 months later) this visit may be reported separately since the global period would no longer apply.

 

[beulastella]

Within the global days post op perioed he turns back to an unrelated condition or any additional complication which is requiring additional management and services that cases we are not supposed to code global Ob code.

 

[Cmama12]

Many of our payers in this area still state that we are able to bill for global even when the patient does not come back for the actual pp visit. They do not expect our providers to wait 6 weeks to bill for services, after determining if the patient will return to the office setting.
Here is information from the UHC Obstetrical Policy.

Q: Should a postpartum visit be provided within the ACOG standard six-week period? A: The postpartum period includes routine office or outpatient postpartum visit(s) usually, but not necessarily, performed 6 weeks following delivery. If a physician routinely performs more than one postpartum outpatient visit in an uncomplicated case, the extra visit(s) is not billed separately. When a postpartum visit is scheduled, but the patient does not keep the appointment, the physician's documentation should reflect that the patient did not appear for the scheduled postpartum visit. This visit does not have to be refunded if a global OB code was previously submitted. If a patient returns to the office well after their scheduled postpartum visit (e.g., 6 months later) this visit may be reported separately since the global period would no longer apply.

I agree.