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Billing E&Ms outside Global OB Package?

  1. #1
    Question Billing E&Ms outside Global OB Package?
    Clearnace Sale
    I have read to append modifier 25 visits that are unrelated to global ob care. Is there confusion when an E&M is billed to the insurance with a 25 prior to the patient delivering and therefore, the global code not yet being billed?

    I also have concerns regarding billing for high risk pregnancies that require more ob visits than the usual. Do most office wait until the patient has delivered to count the total number of visit, to bill additional E&Ms on those complicated visits outside the normal global visits? Are these also appended with 25 or 24?

    Much help is appreciated!:confused

  2. #2
    I just code the date of service based on what the patient came in for. If its a problem visit I use the E &M with a V22.2 pregnancy state incidental code with the DX if its a headache etc. If it is just a prenatal visit then I just code the prenatal visit. The guideline is for high risk patients get 14 and low risk get 10, but if the patient gets seen more than that nothing I can do but show the insurance company we provided the service, although we wont be reimbursed for it. I think the only time that I would use a modifier -25 is if lets say a Rhogam shot was given or something the same day and then I would apply a -25 to the E&M visit, along with the shot codes.
    Last edited by BarbLiimatta; 02-19-2010 at 02:21 PM.
    Barbara Liimatta-CPC

  3. #3
    If I need to bill for a visit that is not part of the global (such as all the antepartum visits because we did not deliver the baby) I use modifer "GB" "not part of global package.

  4. #4
    Kansas City, MO
    Quote Originally Posted by MEDASSURE View Post
    If I need to bill for a visit that is not part of the global (such as all the antepartum visits because we did not deliver the baby) I use modifer "GB" "not part of global package.
    I'm curious is the "GB" that you are using a carrier specific modifier for a service outside the global package? There is a GB modifier in the HCPCS book, but it's to be used for "Claim resubmitted."

    Now, there is one carrier that has a very specific OB Policy that will allow a practice to bill out extra antepartum E/M's over 13 if they were due to complications. If this occurs and the diagnosis is on their covered diagnosis list then you are to submit the E/M with a modifier -25.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

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