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Help with OB/GYN global issue

  1. #1
    Default Help with OB/GYN global issue
    Medical Coding Books
    Dr A provides antepartum care on a patient and now considers this patient to be "his".
    Dr B the covering OB/GYN MD (not a provider in the same OB/GYN group) delivers the baby.
    Dr A provides postpartum care for "his" patient.

    Dr. A wants to bill for the entire package. (which would include Dr. B's delivery because this is "his" patient)
    He can't do this can he?
    Does anyone know of a guideline document that I can show to Dr. A?

  2. #2
    Default
    He didn't deliver the baby, billing a service that was not provided it fraud.

    This happens all the time. A provider intends to do the entire global package but something happens and they don't. That is why there are codes for antepartum care only, delivery only, and postpartum care only.

    I'm a bit stumped at why he thinks he can bill for a service he didn't provide in the first place.

    Laura, CPC, CEMC

  3. #3
    Default
    Thank you, Laura. This helped me!

  4. Default
    It depends on the agreement between the two physician's. Can be a I'll do it for you if you do it for me type of thing. I do not believe this is fraud. It is not double billing.......

  5. #5
    Default What is agreement between physicians?
    Hi dlk;

    My understanding is that this depends on the agreement between physicians.

    Do they cover weekends, holidays and vacations for each other on a regular basis? If so, Dr A may deliver babies for Dr B on the weekend he covers and not bill the delivery charge.

    Ask your physician about his agreement with the other physician to find out if they trade off deliveries.

    Have a good day.

    Susan

  6. #6
    Default
    Thank you, Susan. I will look into this further.

  7. #7
    Default
    I tried to keep quiet but I can't.

    My answer was based on the fact that this provider is in a group practice and the other provider is in a separate group. Generally partners in a group cover for each other, they do not have relationships with other groups. That is one of the advantages of being in a group practice.

    As to the comment that if it is not double billing it is not fraud, please be aware there are more reasons that constitute fraud than double billing.

    Laura, CPC, CEMC

  8. Default
    Per ACOG's 2008 workshop book on Obstetric Coding...page III-18
    Because of the long global period and the unpredictability of labor and delivery, the physician providing the antepartum care may not be available at the time of delivery. Because of this, many practices develop coverage agreements with other practices.

    Arrangements have developed over time to facilitate the reporting of global obstetric codes in most situations.

    If obstetricians from different groups routinely cover for each other, payers generally accept that the primary obstetrician will bill the global package and the covering physician will not bill separately.

    There is more and if you email me your email I will send the scanned page.

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