Ob ptn/Hospital long stay

[Jo Burt]

Is there anyway to bill for a prolonged stay in the hospital if patient has PROM
and high risk. I had a patient that was in the hospital for almost 30 days and the physician did daily visits. According to ACOG, these are part of the global and can not be billed unless, patient has developed other symptoms not related to pregnancy. Any thoughts or suggestions????

 

[Bready]

OB ptn/hospital long stay

Global services are for normal pre-natal care and deliveries. If the pt was admitted to the hospital for monitoring of preterm labor then I would bill for every day seen up to the day before the delivery. I would use 658.13 and a high risk code perhaps V23.41 pregnancy with history of pre-term delivery if that was the case or whatever reason the physician states she was high-risk(hypertension, diabetes etc). If her admission was authorized by her insurance company use that authorization number on your claims too.

 

[MFMcoder]

Ob ptn/Hospital long stay opinion

You can bill for these hospital visits outside the global. If the provider who is going to be billing for the global and delivery is also seeing the patient for PROM, you would have not be able to count them in with the number of global visits. If it is the same provider, you can not bill for a global hospital visit and a high risk hospital visit for that same provider on the same day. That would be double dipping and you probably won't be paid. If it is a different provider than the global provider, the provider managing the high risk of PROM can bill their visits separately even if both providers see the patient on the same day. However, the high risk provider must be of a different specialty than the global provider, especially if they are both in the same practice. For example if the high risk provider is an MFM, then they would have different taxonomy codes. Also to bill for the high risk, you need to clarify if PROM is the "high risk" factor you referred to, or if there is another high risk factor. PROM is a complication and makes this patient high risk, and so again, services for the PROM need carved out of the global. You would also need to use the correct E/M codes (992xx) and not the 59xxx codes.