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OB Global Package

  1. Question OB Global Package
    Exam Training Packages
    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

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    If they are only billing 1-3 visits that's ok...but they can't unbundle the global package.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default
    We only bill individual visits it they are "problem" visits outside of the "normal" ante partum care.
    -Casey

  4. #4
    Location
    San Gabriel Valley
    Posts
    31
    Default 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.

  5. #5
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    Quote Originally Posted by broundy View Post
    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
    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.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  6. #6
    Location
    Gainesville, GA
    Posts
    44
    Default 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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