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Thread: High risk pregnancy

  1. #1

    Question High risk pregnancy

    AAPC: Back to School
    I hope someone can help me or direct me. I work for a HIGH RISK Pregnancy
    group. We are very specialized. My question is, when a patient self refers
    and continues with us through her whole pregnancy and delivers with us.,
    would this be considered global billing? Even though we are HIGH RISK!
    Another question. Once a patient has reached approximately 17 visits, antepartum, can you then start charging E&M visits, if the intent is to be
    Darlene CPC:

  2. #2
    Join Date
    Apr 2007
    Indianapolis Chapter

    Default High Risk Pregnancy


    I hope you found an answer to your question, if not maybe I can help. It does not matter whether the patient self-refers or not for global billing policies to apply. However, many carriers have different policies for billing for pregnancy; some use CPT guidance and you would report the global billing, some allow you to report each visit with an E/M etc. along with the delivery and postpartum care separately. Billing for pregnancy again is carrier specific. Check with the carrier prior to managing the patient in the practice. High Risk may not be a factor in the carrier's determination for coding or payment policy.

    If you are reporting global maternity care, only when the visit is outside of the pregnancy global may you report additional E/M. Example, you have a pregnant mother and let's say she has symptoms of bronchitis. The physician asks the patient come in. Since the reason for the visit is to manage or treat her urgent condition and not particularly manage the pregnancy, you would report an E/M service based on the documentation along with Modifier 25 to indicate that the E/M is outside of the global package. Your diagnosis would be the condition determined by the physician and V22.2 for pregnancy incidential.

    Another reason you might report an E/M if let's say a patient has pre-eclampsia and is admitted to observation prior to delivery. It is related to pregnancy but would fall outside the global if the physician admits to OBS and then later either sends the patient home or admits for delivery is the due date is close. You would report the OBS code with the appropriate level based on documentation with modifier 25.

    I hope this clarifies your questions, if not let me know

    Deb Grider

  3. #3

    Default High Risk Outside Global

    I have a high risk pregnancy practice. All their charges are being denied as bundled into the global maternity package. These providers do not charge global packages and do not do deliveries. Is there a way to get them paid for their services? They do provide lab work and ultrasounds.

    Thank You
    Debbie Garner

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