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Global OB or Split

  1. #1
    Default Global OB or Split
    Medical Coding Books
    I am still relatively new to the OB-GYN coding and this may be a dumb question. When does OB care go from global to split?

    For example: Patient is seen at our office from the start of her pregnancy. We saw her for the history with a nurse and 2 antepartum visits with the physician under insurance #1. Patient continues the rest of her pregnancy and delivers under insurance #2. (two different insurance companies, not just a plan change). Patient has not seen any other provider for this pregnancy.

    I know that we would bill the history, as well as 2 E/Ms for the physician visits to insurance #1. What would we bill to insurance #2? Would we be required to bill 59426 (or 59425 depending on number of visits) and 59410 or can we bill global OB to the second insurance (59400)?

    What confuses me is when the first 3 visits are split out seperately, do they prevent us from billing global OB or is it anything over the 3 visits that constitutes global? The 59400 states it includes antepartum visits, but doesn't say ALL antepartum. Thanks for any input/clarification!

  2. Default
    Could you pleas eread this and se how it helps you!

    From UW Physician -OBGYN Coding:

    [B]Splitting the Global Package[/B
    ]Maternity care and delivery should be billed as a single code except when certain circumstances occur that require the package to be broken including the following:
    • The patient has a change of insurer during her pregnancy
    • The patient has received part of her antenatal care somewhere else (including transfers of care from UWP Family Medicine to UWP Obstetrics and Gynecology)
    • The patient leaves her care before the service is complete
    • The documentation requirements for global billing (above) have not been met
    Antenatal DocumentationWhen a patient receives antenatal care from a UWP provider and the care is not part of a global delivery package (as above), antenatal care must be coded separately. These services may be billed alone or in conjunction with Evaluation and Management (E/M) codes, delivery codes, postpartum codes and other service codes.
    The Antepartum care only codes are used when 4 โ€“ 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer but the global delivery code cannot be billed (see above) and a UWP provider in the same specialty has also performed the delivery.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. In her 21st week she has a change of insurance. The first four visits will be billed to her first insurer with code 59425. The additional 9 visits will be billed to her second insurer with code 59426. The delivery and postpartum care code will be billed separately to the second insurer as well.
    The Antepartum care only codes are used when 4 โ€“ 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer and a UWP provider in the same specialty has not performed the delivery.
    Examples
    • A patient is managed by a facility-employed midwife for 3 visits before the decision is made to transfer her care to an obstetrician due to her history of cesarean delivery. She presents to the General OB Clinic for obstetrical care in the 20th week of her pregnancy. She is seen nine times prior to her scheduled cesarean delivery. The antenatal visits will be billed to her insurer with code 59426. The cesarean delivery and postpartum care will be billed separately.
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen five times prior to moving out of state and changing providers. These visits will be billed to her insurer with code 59425.
    The Antepartum care only codes are used when 4 โ€“ 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer but the package must be broken because of a physician presence or documentation issue.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. The patient's uncomplicated delivery is handled by a resident while the TP is performing a cesarean section for another patient. The antepartum care will be billed to her insurer with code 59426. Postpartum care will also be billed, if appropriate. The delivery will not be billed.
    When fewer than 4 visits are to be billed to an insurer these services are billed using E/M Codes. E/M codes may also be used to bill for extra visits for complicated antenatal care or care unrelated to the pregnancy (see below). Each visit is billed with a separate code. See the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services and the UWP Guidance on E/M Gray Areas for further information on determining which code(s) to use for these services. The Teaching Physician must personally document his or her own presence and participation for each visit to be billed with an E/M code.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. In her 14th week she has a change of insurance. The first two visits will be billed to her first insurer as E/M codes. The additional 11 visits will be billed to her second insurer with code 59426. The delivery and postpartum care code will be billed separately to the second insurer as well.
    When Patients Have Received Antenatal Care Elsewhere, global billing is not appropriate and the services provided by UWP providers must be unbundled. A single visit for evaluation to confirm a pregnancy is not considered prior antenatal care.
    The following sources will substantiate prior antenatal care:
    • The patient's previous antenatal medical records,
    • Contact with the patient's previous provider, or
    • The patient provides information about previous antenatal care, such as the name of previous provider, name of previous care site, number of previous visits, or description of prior antenatal care received.
    If the provider does not have information from one of these sources, he or she will assume that he or she is providing all antenatal care.

  3. #3
    Default
    Here's what I would do... Check with the patient's current (new) carrier. Let them know the date patient entered into your doc's OB care, # and dates of visits done prior to new carrier effective date, and patient's EDC/EDD. Ask them if they will accept a global OB code at the end of pregnancy. If they say yes, then there is no need to split out the global OB care.

    In my experience, most carriers will accept a global in your 2-visit situation. I will do the above carrier check on patients who have 1-3 visits at the beginning of pregnancy before switching carriers. Anything over 3 is usually an automatic global OB split, but again, this can be carrier specific. The key is not to double dip, so to speak. If the new carrer will accept a global OB code at delivery, then be sure you do not bill individual visits to the old carrier.

    While I know this is not following CPT guidelines to the letter, there are many billing rules that are carrier-specific, and this is one of them. Find out what your carrier prefers, and follow their guidelines. It may save you some billing hassle in this case. Of course, if a patient has had OB care elsewhere, then the global OB MUST be split. To do otherwise would complicate your end claim and may result in payment sancture of the previous provider.

    Becky, CPC

  4. Default Split Billing the "mini" Global
    Does anyone know how to split Globlal billing between 2 practices for OB CARE ANTEPARTUM? Example 2nd practice saw patient 7 total antepartum visits. Would I use 59426 for each of those visits? Thanks you for any help!
    Last edited by tamor; 06-25-2014 at 03:27 PM.

  5. #5
    Default
    Quote Originally Posted by tamor View Post
    Does anyone know how to split Globlal billing between 2 practices for OB CARE ANTEPARTUM? Example 2nd practice saw patient 7 total antepartum visits. Would I use 59426 for each of those visits? Thanks you for any help!
    This is ignoring the delivery entirely:
    The 59426 would be billed by the second practice once. The first practice would bill out either e/m codes (for 1-3 prenatal visits) or 59425 (for 4-6 visits). I cannot imagine that the 59426 (7+ visits) would be appropriate.

  6. Default
    When a patient is a transfer in & has 9 visits and a delivery with our provider would you bill a global or split bill?

  7. #7
    Location
    New Braunfels, TX
    Posts
    165
    Default
    Quote Originally Posted by WMIMS View Post
    When a patient is a transfer in & has 9 visits and a delivery with our provider would you bill a global or split bill?
    I would bill global.
    Tracy CPC, COBGC

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