Ob Post-op/global Days

Providence, KY
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Question on OB patient post-op visits. How many visits do you give to an OB patient after they have had the baby? There is no global days on deliveries. My ACOG book states that the normal is 1 free visit for a vaginal delivery and 2 free visits for a cesarean section. We have adopted a policy where I work that everyone gets two visits no matter what. But the problem I have been running into is the doctors are bringing the cesarean patients back in more than the free two visit limit to check their incision. I have one doctor that is giving me trouble about our internal policy. I would just like to find out what other places are doing. I've always thought a cesarean should have a global peroid, but it doesn't.
The standard global package for a vaginal delivery is 6 weeks. In that time period if the patient delivers vaginally, only 1 visit is normally required, the one at 6 weeks. After a cesarean delivery, however, at least 2 visits are required, one soon after delivery to do a routine wound check and one a 6 weeks for the rest of routine postpartum care. But there is no requirement that limits the number of visits the physician believes are necessary during this time frame. Often, as you have pointed out, the physician wants the patient to be seen more often than the usual "limit" but unless the patient is being seen for a complication of the delivery, the visit would still be considered normal postpartum care and should not be billed as an additional visit.

Melanie Witt, RN, CPC-OGS, MA