Wiki ob global antepartum visit

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joyce

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Is there a minimum number of antepartum visits required to bill a global delivery? If a pt has 3 antepartum visits, and we deliver the baby can we bill the global 59400?
 
I don't think you can bill the global package 59400 if only 3 antepartum visits were performed. Per Encode Pro 59400 includes the following:
This procedure covers both antepartum and postpartum care. Antepartum or prenatal care includes the initial and subsequent histories, physical examinations, recording of weight, blood pressures, fetal heart tones, and routine chemical urinalysis. It includes monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery. Postpartum care includes hospital and office visits following delivery.​
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Encoder Pro includes this coding tip: Note that 59400 includes total OB care; if services provided do not match the code description of total OB care, report the appropriate stand-alone code (e.g., antepartum care, 59425–59426). If care rendered was less than the listed service (i.e., the one that most closely describes the service performed), append modifier 52 and reduce the cost of the service. See notes in CPT for directions in the use of the maternity care and delivery codes. For vaginal delivery only, without antepartum or postpartum care, see 59409. For vaginal delivery only, including postpartum care, see 59410.​

I think you have to bill the 3 E&Ms for the 3 antepartum visits, the vaginal delivery and post-partum care.
 
I agree with @CBLENNIE. Some insurance companies have a requirement for a minimum number of antepartum visits. I think the lowest I've ever seen is 7?? Certainly not 3. 3 doesn't even allow you to bill for antepartum visits, and you would bill them individually.
I will also assume/hope with only 3 visits prior to delivery that another clinician was providing care prior. The idea of global maternity is that you are providing all of the care.
 
joyce said:
Is there a minimum number of antepartum visits required to bill a global delivery? If a pt has 3 antepartum visits, and we deliver the baby can we bill the global 59400?
Click to expand...
I was taught the same way, but we can't find anything in writing to validate a minimum requirement. The issue, is pt came to us for only 3 visits, but we did deliver the baby. The guideline does not indicate a minimum per ACOG. So, since we did do antepartum, and delivery that supposedly constitutes global.
If anyone has a source to share, I would greatly appreciate it.
 
CBLENNIE said:
I don't think you can bill the global package 59400 if only 3 antepartum visits were performed. Per Encode Pro 59400 includes the following:
This procedure covers both antepartum and postpartum care. Antepartum or prenatal care includes the initial and subsequent histories, physical examinations, recording of weight, blood pressures, fetal heart tones, and routine chemical urinalysis. It includes monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery. Postpartum care includes hospital and office visits following delivery.​
​
Encoder Pro includes this coding tip: Note that 59400 includes total OB care; if services provided do not match the code description of total OB care, report the appropriate stand-alone code (e.g., antepartum care, 59425–59426). If care rendered was less than the listed service (i.e., the one that most closely describes the service performed), append modifier 52 and reduce the cost of the service. See notes in CPT for directions in the use of the maternity care and delivery codes. For vaginal delivery only, without antepartum or postpartum care, see 59409. For vaginal delivery only, including postpartum care, see 59410.​

I think you have to bill the 3 E&Ms for the 3 antepartum visits, the vaginal delivery and post-partum care.
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I totally agree, issue is proving this concept.
 
For proof, you would need to reference the payor policy. Below are some various requirements.
Require as many as 13 visits:
Require 7 visits:
Require at least 4, and if another provider also provided pre-natal visits, might be global or might be split depending on the number of visits:
All prenatal care be provided by the same practice:
 
csperoni said:
For proof, you would need to reference the payor policy. Below are some various requirements.
Require as many as 13 visits:
Require 7 visits:
Require at least 4, and if another provider also provided pre-natal visits, might be global or might be split depending on the number of visits:
All prenatal care be provided by the same practice:
Click to expand...
thank you
 
joyce said:
Is there a minimum number of antepartum visits required to bill a global delivery? If a pt has 3 antepartum visits, and we deliver the baby can we bill the global 59400?
Click to expand...
There is no "official" minimum number of antepartum visits, but if you look at the CPT guidelines you will see that they think 3 or fewer antepartum visits should be coded separately. Some payers require at least 7 visits to bill globally, but that said, if the payer you are dealing with does not address this issue you can either bill the 3 visits separately and then the delivery with PP care code, or you can bill globally but with a modifier -52 added. You will need to provide the payer with information as to how much of the global care you did not provide so expect a decreased payment.
 
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