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.
Originally Posted by broundy
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
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