Accurately Billing Global Obstetrical Package to Reduce Claim Denials

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials
Challenges of OB/GYN Billing OB/GYN billing and
coding always has been a challenge for most of
billers and coders due to the global claims,
widely varying coverage terms, and multiple tests
performed at numerous facilities. Apart from
this, many OB/GYN practitioners lack the billing
support provided to large hospitals. As Pregnancy
coverage includes inpatient and outpatient
services, billers are not aware how to split
between them. Accurate OB/GYN billing requires a
clear understanding of the criterion that
determines the medical necessity to code for
the various levels of ground and air ambulance
services used. Most billers are not aware of
pregnancy coverage and various billing updates to
an existing insurance plan. Most healthcare
organization loses money as they overlook
separately billable services rendered during the
global period. In this article, we focussed on
accurately billing global obstetrical package
which will help you to reduce claim
denials. Billing Global Obstetrical
Package Defining the Global Obstetrical Package
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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials

• Before we proceed with billing the global
  obstetrical package, let's understand what
  includes the global obstetrical package. As
  defined by the American Medical Association
  (AMA), the total obstetric package includes the
  provision of antepartum care, delivery, and
  postpartum care. When the Same Group Physician
  and/or Other Health Care Professional provides
  all components of the OB package, report the
  global OB package code.
• Antepartum care refers to the serious routine,
  regular obstetrical visits that are spread out
  during the 40 weeks of a typical pregnancy. These
  visits include performing a prenatal history and
  physical exam of the mother, identifying all
  medical factors that could affect the health of
  the baby, and the difficulty of the delivery.
  This phase of care also includes all the routine,
  regularly performed tests to monitor the
  development of the baby.
• Delivery services include the mothers admission
  to the hospital for birthing, the admission
  history and physical exam, management of labor,
  and either vaginal or cesarean delivery of the
  baby. The global package covers an uncomplicated
  delivery, so any significant complications of
  labor and delivery are separately billable if
  supported by appropriate documentation.

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials

• Postpartum care covers outpatient visits for a
  period of six weeks following delivery, during
  which the provider manages the acute effects of
  labor and delivery in the mother while also
  monitoring her general postpartum health.
• Contents of Global Obstetrical Package
• The Current Procedural Terminology (CPT) book
  identifies the global OB codes as 59400, 59510,
  59610, and 59618.
•  
• Services Included in the Global OB Package
• All routine prenatal visits until delivery
  (approximately 13 for uncomplicated cases)
• Initial and subsequent history and physical exams
• Recording of weight, blood pressures, and fetal
  heart tones
• Routine chemical urinalysis (CPT codes 81000 and
  81002)
• Admission to the hospital including history and
  physical
• Inpatient Evaluation and Management (E/M) service
  provided within 24 hours of delivery

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials

• Management of uncomplicated labor
• Vaginal or cesarean section delivery (limited to
  single gestation)
• Delivery of placenta
• Administration/induction of intravenous oxytocin
• Insertion of a cervical dilator on the same date
  as delivery
• Repair of first- or second-degree lacerations
• A simple removal of cerclage (not under
  anesthesia)
• Uncomplicated inpatient visits following delivery
• Routine outpatient E/M services provided within 6
  weeks of delivery
• Postpartum care only
• Educational services e.g., breastfeeding,
  lactation, and basic newborn care
• Services Excluded from the Global OB Package
• Initial E/M to diagnose pregnancy if the
  antepartum record is not initiated at this
  confirmatory visit. This confirmatory visit would
  be supported in conjunction with the use of
  ICD-10-CM diagnosis code Z32.01.

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials

• Laboratory tests (excluding routine chemical
  urinalysis)
• Maternal or fetal echography procedures (CPT
  codes 76801, 76802, 76805, 76810, 76811, 76812,
  76813, 76814, 76815, 76816, 76817, 76820, 76821,
  76825, 76826, 76827 and 76828).
• Amniocentesis, any method
• Amnioinfusion
• Chorionic villus sampling (CVS)
• Fetal contraction stress test
• Fetal non-stress test
• External cephalic version
• Insertion of cervical dilator more than 24 hours
  before delivery
• E/M services for the management of conditions
  unrelated to the pregnancy (e.g., bronchitis,
  asthma, urinary tract infection) during
  antepartum or postpartum care the diagnosis
  should support these services.
• Additional E/M visits for complications or
  high-risk monitoring resulting in greater than
  the typical 13 antepartum visits
• Inpatient E/M services provided more than 24
  hours before delivery.

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials

• Critical care services that are unrelated to the
  specific anatomic injury or general surgical
  procedure performed, within a global surgical
  period.
• Management of surgical problems arising during
  pregnancy (e.g., appendicitis, ruptured uterus,
  cholecystectomy)
• Global Obstetrical Package (59400, 59510, 59610,
  59618)
• Separate reimbursements for services provided
  during the pregnancy that are included in the
  global obstetrical package for uncomplicated
  maternity cases are not allowed. The provider can
  only bill for the global obstetrical delivery if
  the same physician began routine antepartum care
  prior to the 28th week of gestation and continued
  care through the delivery and postpartum period,
  the physician must bill the appropriate code for
  total obstetrical care.
• Global Obstetrical Delivery Post-Operative Care
  (59410, 59515, 59614, 59622)

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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials
Evaluation and Management services and postpartum
care billed for a date of service within a 42-day
time frame will bundle into the global delivery
service when billed by the same provider
performing the delivery service, except when the
EM is unrelated to the obstetrical care or is
related to a maternity complication. Global
Obstetrical Delivery Post-Operative Care (59410,
59515, 59614, 59622) Evaluation and Management
services and postpartum care billed for a date of
service within a 42-day time frame will bundle
into the global delivery service when billed by
the same provider performing the delivery
service, except when the EM is unrelated to the
obstetrical care or is related to a maternity
complication. Antepartum Care (59425 and
59426) It is not appropriate for a single
provider to bill more than one 59425 or 59426 in
any combination during the antepartum period. If
more than one of the Antepartum Care codes is
billed by the same provider in a 240-day period,
the subsequent billed codes will be
denied. Delivery Only (59409, 59514, 59612,
59620) Per the CPT book, Delivery services
include admission to the
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Accurately Billing Global Obstetrical Package to
Reduce Claim Denials
hospital, the admission history and physical
examination, management of uncomplicated labor,
vaginal delivery (with or without episiotomy,
with or without forceps), or cesarean
delivery. Antepartum Care by Different Provider
Groups When more than one provider group renders
a portion of the antepartum care to a pregnant
patient, it is inappropriate for the delivering
physician to bill with a global obstetrical
delivery code. The provider can only bill for the
global obstetrical delivery if the same physician
began routine antepartum care prior to the 28th
week of gestation and continued care through the
delivery and postpartum period. Medical Billers
and Coders (MBC) is a leading medical billing
company providing complete medical
billing and coding services. We referred various
payer reimbursement policies and shared detailed
information on billing global obstetrical
package. You can refer payer specific billing and
coding guidelines for accurate insurance coverage
for the global obstetrical package. You can refer
our OB/GYN billing services to reduce claim
denials and to receive accurate insurance
collections. To know more about our OB/GYN
billing and coding services, email us
at info_at_medicalbillersandcoders.com or call
us 888-357-3226.