Wiki Question about OB visits and global billing!

[Stephanie39]

I am a path/lab coder, and I have been presented with an OB/GYN billing scenario I was hoping someone could help me with.
A patient has presented to a specialty OB office in our hospital network, specializing in high risk pregnancies, such as patient's with pre-existing diabetes, as is the case with this patient. If this office is the only treating office for the duration of this patient's pregnancy, do they bill for the global prenatal period, or since this is a specialty office, can they bill separately for each prenatal visit?

 

[Kiana]

Antepartum visits only are 59425 & 59426 the 59426 is for 7 or more then code your high risk codes diabetes codes for your dx.

 

[Stephanie39]

would it matter that the attending OB is a specialty office? My understanding is that they normally don't do full prenatal care, but that they do make acceptions, as is in this case. They would like to bill for a specialty visit (E & M) each time this patient comes in, which would result in the patient paying a co-pay each time, instead of billing for a global maternal period. My gut is that it should be a global maternal period, but I'm also on the fence because of the high risk/specialty issue.

 

[truescaper]

contact the insurance carrier

Hi, Does the specialty office have a contract with the high risk client's insurance? How the office/providers are credentialed might have some bearing on the global vs E/M question. I would contact the carrier.
Terri

 

[Stephanie39]

yes, they do have a contract with the insurance carrier. Apparently the insurance provision is not in question, it is the office who does not want to bill globally.