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broundy

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An outside office informed us today that they are billing for OB visits individually to all the insurances? I bill global and was just wondering if anyone else does this. I know it would be done separately if the visits are split etc but if you take the patient from the beginning of the pregnancy to through the postpartum, I did not know you could bill visits individually. I was wondering if there is anyone out there doing this especially with commercial insurances.

Thanks

Bonnie
 
global package

If the patient is Med-i-cal they want you to bill per visit but they are z codes.
the other postings are correct.
 
broundy said:
An outside office informed us today that they are billing for OB visits individually to all the insurances? I bill global and was just wondering if anyone else does this. I know it would be done separately if the visits are split etc but if you take the patient from the beginning of the pregnancy to through the postpartum, I did not know you could bill visits individually. I was wondering if there is anyone out there doing this especially with commercial insurances.

Thanks

Bonnie
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Bonnie, Interesting use of coding. This practice is called fragmenting. Basically splitting (fragmenting) services that should be reported with a more comprehensive code. For example, if they provided the antepartum, delivery, and post partum care, the appropriate codes is the global service code. Fragmenting the office visit, delivery, etc is not appropriate regardless of the payer. I am the compliance analyst for a payer and an independent consultant and have seen this type of billing.

When the ante, delivery, and postpartum care are all done by the same group, the global service should be billed. Sometimes this happens when a provider group wants to identify when different individual providers within their practice sees the patient. They need to do this so they can pay their providers based on the services they provide. How they identify how to reimburse their physicians is an internal business issue and does not change the coding rules. I hope this is helpful.
 
global vs time of service

They may have a differnt contract than you. More times than not you have to bill globally. Check your payer contracts to see. It is sometimes benefical to bill non-glboally.

Also, are they gerneralist or specialist such as MFM? Is the care "rountine" or high risk? All things to take into consideration.
 
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