Coding / Reimbursement Vaginal First Newborn 59400, 59409, 59410, 59610, 59612, or 59614 (usually 59400 or 59610) for the first • Use the appropriate vaginal delivery code newborn. Shape of the nose 4. Coders should bill for the antepartum and postpartum services provided by Dr. Smith. Process consultation 4. This is not an all-inclusive list, but it gives coders an idea of diagnoses and symptoms that may place the patient in a “risk” diagnosis area: Billing nonpackage-related procedures in addition to E/M services requires good documentation and good communication between coders and physicians. Coders are encouraged to know what these procedures are and when to properly report these. The OB package works well for patients who see the same physician for the entire duration of their pregnancy, delivery, and postpartum care. Common ancillary procedures and services include the following: Complex OB/maternity coding and billing scenarios. The American College of Obstetrics and Gynecology (ACOG) has written an article which can be found in the citations section, which is helpful. Use the 1995 Documentation Guidelines for Evaluation and Management Services or the 1997 Documentation Guidelines for Evaluation and Management Services to audit maternity care. So you know you can report additional visits for complications outside the normal global ob package, but do you know how to make sure your claim sails through the reimbursement process? The separately identifiable complications or diagnoses may not be pregnancy-related. Scenario 2: The patient has received antepartum care with Dr. Smith, but Dr. Dumore, who is unaffiliated with Dr. Smith’s office, provides the delivery care. Codapedia.com provides freely available information on reimbursement for physician services by providing user-generated content related to billing, coding, collections, and compliance for medical practices. Note from the instructor: CMS clarifies billing guidelines on proper billing for drugs in a single-dose or single-use vial, including billing for discarded drugs, Maxim moment: Success measurements in CDI, Injections and infusions continue to confuse coders, ICD-10 anatomy refresher: Digestive system, Quiz questions your staff needs to know to prepare, 59400: Routine OB including antepartum, vaginal delivery, and postpartum care, 59510: Routine OB including antepartum, cesarean-section (C-section), and postpartum, 59610: Routine OB including antepartum, vaginal birth after C-section (VBAC), and postpartum, First prenatal visit or initial evaluation, including a history and physical (H&P) exam, Pregnancy evaluation and progress screening (i.e., subsequent or interval H&P exams, recording of weight, blood pressure, specimen handling, and routine automated chemical urinalysis), Care of complications during the gestational period specific to obstetrical care or that constitute the management of a, Supervision or management of uncomplicated labor, including induction services, Initial evaluation and resuscitation of the newborn by the obstetrician, Fetal scalp blood sampling and application of fetal scalp electrodes and electronic fetal monitoring. ... A physician practice may bill patients for some services outside the package. This webinar content will follow the Coding & Billing Guidance Document, Part II, version 5 ... DMA will only pay this incentive if an OB package code that includes postpartum care is billed. components of the OB package, report the global OB package code. She also requests a flu vaccine. July 29th, 2016. Sensitivity technique 2. Color of a person’s eye 2. Scenario 1: The patient received antepartum care with Dr. Smith. The products and services of HCPro are neither sponsored nor endorsed by the ANCC. In these cases, the coder needs to audit and bill only for the antepartum services that the patient received prior to the miscarriage. The routine follow up visit after delivery as … If by chance a patient requires services outside the OB package, it is appropriate for coders to bill for them. The easiest way to get the text of the article is to highlight and copy. Dr. Smith does the postpartum care. The 25 modifier should be appended to the E/M codes to indicate that the visits are outside of the global surgery period. Review the CPT codes and bill the appropriate E/M code for the service provided. Coders should code and bill for Dr. Smith’s services. Dr. Smith does the postpartum care. Use the medical diagnosis first and the pregnancy diagnosis separate. Code the visit as an established comprehensive E/M visit – 99215, since ... • Antepartum Package Services codes are based on number of visits • 59425 – Antepartum care only, 4 - 6 visits The following are part of the routine OB visit: CPT coding is not the only challenge in obstetric/maternity coding. OB services: Coding inside and outside of the package; Know the medical gas cylinder storage requirements; Intravenous therapy guidelines; Coding, billing, and documentation tips for teaching physicians, interns, residents, and students; Coding tip: Watch for different codes for SI joint injections; Searched; cold weather preparedness in hospital Visits outside the OB Global Package July 27th, 2015 - Codapedia Editor. Print Version: The CPT® book defines which services may be billed outside of the global OB package, and what services are included in the package. OB related problems (PTL) Problem Visits •Patient presents with dysuria and frequency •Pti tPatient comes to the office for monit iitoring of bl dblood pressure •Diabetic patient with problems These can be billed outside the global package if there is adequate documentation 10 Dr. Dumore will need to bill separately for the laceration repair during the delivery. Physicians commonly see patient for approximately 13 antepartum visits; however, that is not always the case. Per ACOG coding guidelines, reporting of third and fourth degree lacerations should be identified by appending modifier 22 to the global OB code (CPT codes 59400 and 59610) or delivery only code (CPT codes 59409, 59410, ... ACOG, the MFM services fall outside the routine global OB package. In addition, he performs a sterilization procedure immediately after the C-section. CPT Coding CPT defines maternity-related services as: 59400Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care. One visit every four to five weeks up to 28 weeks, One visit every week from 36 weeks until delivery. However, do not bill a separate E/M visit performed on the same day as a planned procedure. The diagnosis should also reflect the separately identifiable service. It describes common scenarios, such as patients who transfer in or out of the practice during their pregnancy. Or use your browser's "View Source" option to capture the HTML formatted code. If you would like a specific article written on a medical coding and billing topic, please Contact Us. ICD-9 codes 640–649 and 651–676 require a fifth digit. Cesarean delivery; two inpatient visits, one discharge; codes 99231, 99232, 99238. Questions/comments may be sent to ACOG's Coding Staff via email at coding@acog.org E-mail her at LORIWEBB@sarmc.org. Below is a listing of common OB/maternity complication diagnoses. These … CPT has some general coding rules that coders should follow closely when using a package code (i.e., 59400, 59410, and 59610) CPT does not specify that a physician must provide a certain number of visits to use the global OB package. The Current Procedural Terminology (CPT®) book identifies the global OB codes as: 59400, 59510, 59610 and 59618 UnitedHealthcare reimburses for these global OB codes when all of the antepartum, delivery and postpartum care is The following antepartum services are normally included in the package. The total obstetric care package includes the provision of antepartum care, delivery services and postpartum care. Coding Guidance May 12, 2017 1 2 Purpose/Objectives This webinar is in an effort to clarify billing/coding expectations within ... the patient’s first visit with the Ob provider. The article must be published in its entirety - all links must be active. by Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA. Components of the Global Package. The accepted norm for these services is to bill a global package for the first baby and a delivery only code for the second or subsequent baby(ies). Ask Questions, Get Answers The ACOG Coding Question Database is a Member service, with Fellows receiving the highest priority for responses. Identifying the CPT package codes From packaged services to multiple gestations, obstetric (OB)/maternity care coding is no small challenge. 0 Votes - Sign in to vote or comment. ... A separate E/M service should not be reported because the office visit is part of the global obstetric package. Deciding when to initiate the global OB care depends on the clinical circumstances, the physicians’ medical judgment, and payer reimbursement policies. If the patient has a complication of pregnancy, or an acute problem, and is seen more frequently than at the intervals described in this section of the CPT® book, submit those separately, at the time they are performed. • The primary procedure will be allowed at 100% of the contracted rate, subject to the member’s contract benefits. And of course, there is also the challenge of coding for multiple gestations. Third and fourth degree laceration repairs are separately identifiable services. Whether you are new to the role of Coding Manager, transitioning... Our experts address new AKIN criteria, acute vs. chronic kidney disease, and other clinical aspects of renal failure and... *MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). CODING & BILLING GUIDANCE DOCUMENT Maternal Health September 27 & 28, 2017. The CPT® book defines which services may be billed outside of the global OB package, and what services are included in the package. When a physician provides care of or surgical intervention for the miscarriage or ectopic pregnancy, the coder would also need to bill for those specific services too. Inpatient hospital admission directly related to the pregnancy for a period of six weeks. Read on to make sure you're coding the full picture. B. There are also occasions when a physician may see a patient for an illness or injury that relates to the pregnancy (e.g., sciatic nerve impingement, back pain, abdominal pain, or even knee sprain/strain due to additional pregnancy weight). This article is available for publishing on websites, blogs, and newsletters. The CPT book also includes a section for Fetal Invasive Procedures that are billable outside of the global OB package and include both diagnostic and therapeutic services. Some insurance payers have specific billing requirements for these services. The patient has Medicare. Editor’s note: Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, is an independent consultant in Melba, ID. There are services that may or may not relate to the pregnancy which are outside of the Global OB care and should be reported separately. Dr. Jones, who is in the same practice as Dr. Smith, provides the delivery. OB Coding – The Global Package & Beyond Kerin Draak, MS, WHNP-BC, CPC, CEMC COBGC k i d@Pkerind@Prevea.com You Will Learn • How to code for routine pregnancy services • What services are billable outside the OB global package • How documentation is required to look to support routine care. (2016, July 29). A few of you commented on the diagnosis codes that should be used. Coding/Billing Information.....6 References .....8 Policy History/Updates.....8 Related Policies ... Cigna provides reimbursement for the Global Maternity/Obstetric Package when reported with the appropriate Current Procedural Terminology (CPT®) code (59400, 59510, 59610 or 59618) by a health ... Cigna will reimburse specific medically indicated services outside of the Global Maternity/Obstetric Coders should code and bill the package first, then report the correct CPT code for sterilization services provided during post-vaginal delivery within the maternity stay. It is a program to bring a change in the values, norms, attitudes, perception, and behavior of people and improve the quality of inter-personal relations. Association of Clinical Documentation Improvement Specialists, 1997 Documentation Guidelines for Evaluation and Management Services. Coders should code and bill the package first, then report the correct CPT code for sterilization services provided post C-section within the maternity stay. The crux lies with your ICD-10 codes. Answer 1: You should wait until the next visit to start the OB global package, otherwise your carriers will consider the whole visit part of the OB record. Also use the CPT Manual’s single system female exam or the multi-system exam criteria as well as the Medicare Benefit Policy Manual. Plus, the reason for the patient’s visit is her annual exam (99384-99386 for new patients or 99394-99396 for established patients), and your physician incidentally learns that she is pregnant during the visit. Coding for OB services can be complicated; per the CPT® guidelines the global OB package includes uncomplicated care to the patient in the antepartum period, delivery and postpartum period. Vaginal delivery; one inpatient visit, one discharge; codes 99231, 99238. Coders must be prepared to review, audit, and bill for E/M services that are OB/maternity related, but are not part of routine care. Also, the visit should be out of sequence, that is, not one of the regularly scheduled visits. Retrieved from https://www.findacode.com/articles/visits-outside-the-ob-global-package-28115.html. The OB package starts with the first OB visit: when the group begins the data collection and service. If by chance a patient requires services outside the OB package, it is appropriate for coders to bill for them. If the patient has a complication or requires additional workup or care, coders should assign the appropriate E/M code (i.e., 99212–99215) to reflect the separately identifiable service. 4-6 antepartum visits, delivery and postpartum care – Bill the appropriate global surgery code with the 52 modifier appended to indicate reduced services. The fifth digit plays an important part of telling the story to the insurance carriers.