Wiki hospital rounds after delivery

[metzger130]

I am in Ohio and our Medicaid does not follow a "global package" when it comes to pregnancy. We bill out each visit as an office visit and then the delivery as delivery only. My question is, if the patient delivers and then the next day they do rounds in the hospital and see the patient can you bill that or not? I am leaning as you can bill it since there is no global package for Medicaid, but at the same time I am thinking no since they just delivered. Any help would be appreciated!

Rob

 

[thomas7331]

I have not billed within Ohio so am not speaking from direct personal experience, but the Ohio Medicaid regulations do state: Inpatient hospital visits following surgery. No separate payment is made for an E&M service provided within the postoperative period for a covered surgical procedure. The postoperative period, which is listed in appendix DD to rule 5160-1-60 of the Administrative Code, includes the day of surgery. In the appendix, they do identify delivery codes as having a 45-day postoperative period, so I would interpret this to mean that they do apply a surgical global package even if they don't have an obstetrical package and would not pay for these hospital rounds.

The fee schedule has just recently been updated and does show new payment rates for the global OB codes, so perhaps they are about to change their policy on this?

 

[metzger130]

Thank you for the information, I was thinking it wouldn't be billable, but with Medicaid it gets very confusing. I am wondering where you found the new changes for Ohio Medicaid. The only fee schedule I can find was updated on 1/1/18.

 

[thomas7331]

Thank you for the information, I was thinking it wouldn't be billable, but with Medicaid it gets very confusing. I am wondering where you found the new changes for Ohio Medicaid. The only fee schedule I can find was updated on 1/1/18.

Agreed, the Medicaid regulations are notoriously confusing. There's a 7/1/18 revision to the fee schedule here: http://codes.ohio.gov/pdf/oh/admin/2018/5160-1-60_ph_rv_a_app1_20180425_1233.pdf
But is shows the same thing as the 1/1/18 revision for the OB codes - a 'NC' indicated under 'previous maximum payment amount' but $1175.28 for 'current maximum payment amount' for the global 59400. I'd be curious to know why they have a payment rate for that code if they don't allow it to be billed.