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Thread: Late transfer to care

  1. #1

    Default Late transfer to care

    AAPC: Back to School
    A question that frequently is asked by our midwives:

    How many visits must occur before it is considered "global care"?

    Many pregnant women see a physician for awhile, then decide to switch to a midwife. I know payers each have their own guidelines (4+ visits, 7+ visits, three months, etc), but are there any definitive guidelines in CPT?

    ~Kelli S
    Last edited by sugihara; 03-04-2011 at 06:09 PM.

  2. #2


    CPT Handbook for office based Coding-AMA /CPT Perspective:
    (Page 274) The guidelines at the beginning of Maternity care and Delivery Subsection define the service included when Antenatal care , Delivery service and Postaprtum care are reported.

    My perception genarally, the prenatal mandatary rules about prenatal visits are in compliance with the obstetrical guidance which is: monthly from the time of knowledge/confirmation/ first visit of pregnancy till the end of 2nd trimester(28completed weeks); fortnightly from thence till 36completed weeks; then weekly till the 38- 40weeks; from 36weeks onwards it is as frequently as per the physician's discretion, evaluation and the condition of the mother and the fetus(for the benefit of doubt, circumstances and for the benifit of better outcome of pregnancy, not necessarily have to be a high risk pregnancy to have that much of frequency of visits.
    So, a minimum of 7- 8 visits (till 28 wks) ; 4 visits (till 36 weeks); 4-6 visits (till 40 weeks) and much more frequently from 40-42weeks (actually from the 38wks), as much as the physician schedules/advices.
    So, the mathematics goes upto 18 antenatal visits from the start to the culmination of pregnancy. (for a normal pregnancy)

    So the the OB rules for the prenatal visits could have been taken for granted/or hallmark for the CPT prenatal visits guideline.
    Thank you for tuning in and for your time.

  3. #3


    Thank you for your answer, but I'm not sure I worded my question clearly. Here are some examples:

    A woman sees a physician early in her pregnancy, then decides to have a home birth with a midwife. She is 18 weeks pregnant when she begins care with the midwife, and has the regularly scheduled visits until delivery. Can this course of care be billed with the global code 59400?

    If a woman transfers care to the midwife at 28 weeks (and follows the regular visit schedule), can the course of care be billed with the global code?

    Of if she transfers care at 36 weeks and has 8 visits with the midwife before she delivers, can that be billed with the global code?

    Where is the cut off? From you email, it sounds like 18 visits are required before one can bill the global code, but I don't imagine that was your intent.

    Thank you!

  4. #4


    I have reread the CPT guidelines and I still do not see any minimum requirements in order to bill the global code, 59400. Am I safe to assume this is carrier specific?

    Any input is appreciated.

    ~Kelli S.

  5. #5


    This question was answered on another thread, 'Global OB or split' by Bonzaibex. Thanks!


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