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global or not....

  1. #1
    Red face global or not....
    Medical Coding Books
    We have a patient that was seen at 16wk, 27wk and 39 wk, then delivered. She either cancelled or no showed every other appointment. Do I break this apart or do I bill the global. Everything that I read, tends to be toward the fact that the patient got care somewhere else and that would be the reason for breaking it apart. I can't find anything definitive on this particular case. Any help would be appreciative.

  2. #2
    Default
    My initial thought is to split this out and bill E&M codes for the three OB visits, appropriate code for the delivery and then bill the pp visit if/when it happens. But, to be certain, I would recommend calling the payer and explain the situation to them - then you can be certain they get the charges the way they want them billed. I have not run into this scenario yet in our office - always something new and different
    Leandra Tufts, CPC, CEMC, COBGC

  3. #3
    Location
    Bangor, Maine
    Posts
    29
    Default
    I would agree with the 3 E/M codes and then the delivery and PPV if that happens. Typically I send a letter along with my charges explaining that CPT directs us to bill E/M codes when the pt is seen for 1-3 visits. This saves me time, because 9 times out of 10 our carriers deny the charges.
    Devon Crossman, CPC
    Billing and Coding Specialist, Bangor OB/GYN

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by huntersmum View Post
    We have a patient that was seen at 16wk, 27wk and 39 wk, then delivered. She either cancelled or no showed every other appointment. Do I break this apart or do I bill the global. Everything that I read, tends to be toward the fact that the patient got care somewhere else and that would be the reason for breaking it apart. I can't find anything definitive on this particular case. Any help would be appreciative.
    If your provider did ALL of the antepartum care, plus delivery and postpartum care, you can still bill the global fee even if she only showed for 3 visits. If the patient was seen anywhere else for any part of her care, then you would definitely split the billing out.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    I agree with the 3 E&M codes and the delivery. However, you can't bill the postpartum care separately if you performed the delivery. Those are included in the delivery; if you only did the delivery and she gets postpartum care elsewhere, then you can bill delivery only.

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