Wiki When to add 52 mod to global OB billing

[Lb6731@hotmail.com]

Hello Everyone,

Any advice as to when to add a 52 modifier to the global OB code of 59400 or 59510? I was taught that if the provider did not perform 10+ ante partum visits, and/or the patient delivered prior to 36 weeks, then add the 52 modifier.

What does everyone else do? Seems like more of a gray area than what I believed.

Thank you!

 

[csperoni]

I'm currently adding more OB coding to my skill set and I believe this may be mostly carrier specific.
I have seen some carriers not recognize -52 on global OB.
At least 1 carrier states -52 on global OB if less than 7 ante-partum visits.
I have seen several carriers state bill global OB (no modifier) if at least 4 ante-partum visit.
Unless there is specific carrier advice, if at least 7 antepartum, I would bill global maternity.
If less than 7 antepartum, I would bill separately for the delivery with postpartum, and antepartum.
So if 5 antepartum, vaginal delivery and postpartum:
59425 for 4-6 antepartum
59410 for delivery and postpartum