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OB coding global or non global

  1. #1
    Location
    Albuquerque, NM
    Posts
    52
    Question OB coding global or non global
    Medical Coding Books
    Sorry, if this subject has been addressed before but we are having a huge disagreement on how to bill the following scenerio:

    Patient presents to office at 23 weeks has not had any prenatal care and doctor delivers and we do postpartum care. Code 59400 correct?

    Patient transfers at 23 weeks from Dr. A in New York to our Dr. B in New Mexico, we take over care, deliver and do postpartum. Code 54925 &
    59410 Correct?
    Or would Dr. A bill e&m and we could bill global 59400-52 due to not seeing patient for total global package.


  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Quote Originally Posted by penny48 View Post
    Sorry, if this subject has been addressed before but we are having a huge disagreement on how to bill the following scenerio:

    Patient presents to office at 23 weeks has not had any prenatal care and doctor delivers and we do postpartum care. Code 59400 correct?

    Patient transfers at 23 weeks from Dr. A in New York to our Dr. B in New Mexico, we take over care, deliver and do postpartum. Code 54925 &
    59410 Correct?
    Or would Dr. A bill e&m and we could bill global 59400-52 due to not seeing patient for total global package.

    I would code the delivery and postpartum for the first senario. You might want to attach the note and add a 22 modifier, if it warrants.

    How many weeks before she delivered? The other office may have billed out the antepartum so you would only be able to bill the visits and the delivery anyway. That is my recommendation.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Location
    Cedar Rapids, Iowa
    Posts
    6
    Default
    I work for an OB/GYN and run into both of these scenarios. I hope I am of service to you.

    Some insurance carriers ask that we keep in mind as a "rule" when it comes to antepartum care and deliveries "some are easy and some are hard". Meaning some patients are seen with little to no antepartum care and some are seen over the "usual" amount of 13 antepartum visits. With that said the first scenario you suggested we would bill for the delivery and postpartum care 59410 - clearly this is the only care you truly provided. However if you are SURE that the patient did not obtain any antepartum care elsewhere and she was in fact seen AT LEAST once prior to her delivery under your care then this one could be considered "an easy one" and you could bill the entire global package 59400 (possibly adding the 52 modifier for reduced services). You have to be sure that there isn't another office out there trying to get reimbursement for the work of the antepartum care 59425-59426. Which brings us to the second scenario. You cannot bill either of the codes 59425-59426 AT ALL if there is a previous provider billing for any/all of the antepartum care.

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