Medical Reimbursement Professionals Exchange

[Erica Schwalm]

The global obstetrical package (OB Package) Includes:

? Prenatal Visits ?includes initial and subsequent history, physical exams, recording of weight, blood pressure, and fetal heart tones, & routine urine dipstick analysis), approximately 13 visits are normal but it may be slightly less. There must be at least 6 visits (for most payors - contact your payors to be sure) in order to bill the global delivery code.

- Monthly visits up to 28 weeks
- Biweekly visits from 29 - 36 weeks
- Weekly visits from 36 weeks through delivery

If a patient presents with signs or symptoms of pregnancy and the patient is there to confirm pregnancy, this visit my be reported with the appropriate level of E/M as long as the OB Record is NOT initiated at this visit. If the OB Record is initiated at this visit, then the visit becomes part of the OB Package and is not billed.

? Delivery Services (includes admission to hospital, admission H & P exam, management of uncomplicated labor, the delivery itself, use of forceps, episiotomy, induction of labor, artificial rupture of membranes, and delivery of placenta)

? Postpartum Services (includes routine hospital visits and office visits during the global period)

- The postpartum period is usually 6 weeks (42 days) following the delivery (again some payors might have slightly different guidelines)

The codes for global deliveries including prenatal and postpartum care are:
? 59400 ? Vaginal
? 59510 ? Cesarean
? 59610 ? VBAC (vaginal delivery after previous cesarean)
? 59618 ? Attempted VBAC (cesarean delivery following attempted VBAC)


NOT Included in the OB Package (These services CAN be billed):

? The initial pregnancy test
? All routine labs (excluding routine urine dipstick)
? Routine Venipuncture (36415)
? Administration of RH immune globulin (90772)
? Ultrasound testing
? Fetal biophysical profiles, non-stress tests, and fetal echocardiography
? Amniocentesis and cordocentesis
? Office or hospital visits for complications of the pregnancy or medical issues unrelated to the pregnancy


Physicians Performing Less Than the Full OB Package ? Sometimes the physician may not be able to bill for the global delivery code. This may occur when the patient:

? Transfers into or out of the practice (changes doctors, moves from another city, etc.)
? Delivers elsewhere (was on vacation, regular physician was unavailable, etc.)
? Terminates or miscarries her pregnancy
? Does not comply with prenatal care (does not show up for at least 6 prenatal visits)
? Switches insurance during the pregnancy

In these cases, the physician may report one or more of the following codes as appropriate depending on the circumstances:

? An E/M code for each visit if the patient has less than 4 prenatal visits.
? An antepartum only code:
---59425 for 4 ? 6 prenatal visits
---59426 for 7 or more prenatal visits
? Delivery only codes (59409, 59514, 59612, or 59620)
? Delivery plus postpartum care codes (59410, 59515, 59614, 59622)
? Postpartum care only (59430)

EXAMPLES:

A patient, who had 5 prenatal visits, moves to another state during her 5th month of pregnancy.
- Bill 59425 for antepartum care only

A patient visiting here from another state delivers vaginally. She will follow-up with her doctor at home.
- Bill 59409 for the delivery only

A patient with only 5 prenatal visits delivers vaginally. She will return for a postpartum checkup.
- Bill 59425 for the antepartum care
- Bill 59410 for delivery and postpartum care

A patient has 10 prenatal visits while on MassHealth then switches to BMC HealthNet right before she delivers. She also had postpartum care while on BMC HealthNet
- Bill 59426 to MassHealth for the prenatal visits.
- Bill 59410 to BMC HealthNet for the delivery and postpartum care

A patient has miscarriage in her 10th week of pregnancy. She was seen prior to the miscarriage for 2 prenatal visits.
- Bill out the 2 E/M codes only

* When billing antepartum care only (59425 or 59426), use the date of the last prenatal visit as the date of service *



Billing for Early Deliveries or Delivery of an IUFD (intrauterine fetal death):

? If infant is live born, a delivery code may be billed regardless of gestational age.
? If IUFD, gestational age must be greater than 20 weeks in order to bill a delivery.
? For IUFD delivery under 20 weeks, can?t bill for delivery. Bill only E/M code and prolonged services if documented.
? Review patient?s account and bill out any prenatal visits she had prior to the early delivery or IUFD.


Treatment of missed abortion or incomplete abortions:

Definitions:

Missed abortion ? Early fetal death before 22 weeks gestation with retention of fetus.

Incomplete spontaneous abortion ? Spontaneous premature expulsion of some products of conception form the uterus with retention of remainder.

Septic abortions - those in which intrauterine infection is present

59820 ? Surgical treatment (suction curettage) of missed abortion, 1st trimester (up to 14 weeks)
59821 ? Surgical treatment (suction curettage) of missed abortion, 2nd trimester (14 ? 22 weeks)
59812 ? Surgical treatment of incomplete abortion, any trimester
59830 ? Surgical treatment of septic abortion, any trimester

(When a spontaneous abortion that is complete (any trimester) occurs and the physician manages the patient medically, with no surgical intervention, bill the appropriate E/M code.)



Coding for Multiple Births:

This can be tricky because there are a few different methods for reporting multiple births and each payor should be questioned to see what they prefer.

One method is to bill the global vaginal delivery code for Baby A and the delivery only code with either a modifier ?59 or ?51 appended for Baby B (and so on for each additional baby for triplets, etc).

Another method is to bill the global vaginal delivery code with modifier ?22.

For cesareans, the global cesarean code should only be billed once, since there is only one incision, possibly with a modifier -22.

REMEMBER: If using a modifier ?22, documentation must be sent with the claim. The documentation should reflect the extra work involved in delivering the multiple births.


Erica
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Erica Schwalm, CPC, GSS, CMRS
www.ericacodes.com