What if the patient is high-risk in another way, and needs more frequent visits than those includ… Coding and billing for maternity obstetrical care is quite a bit different from other sections of the American Medical Association Current Procedural Terminology (CPT). Make sure you double check all insurance guidelines to see how MFM services should be reported if the provider and MFM are within the same group practice. A�V2��dh��dq�H�T�O� @��ֲ��^h�xX���d����&�q��n�i���s(���nb%N�Mfr\�M;NAY�! All E&M codes are subject to global maternity period coding guidelines. Consult plan documents for specific routine maternity benefits. Others may elope from your practice before receiving the full maternal care package. Appropriate image(s) demonstrating relevant anatomy/pathology for each procedure coded should be retained and available for review. Submit all rendered services for the entire nine months of services on one CMS-1500 claim form. Let’s begin by examining the antepartum period, delivery, and postpartum period separately. For information related to those items covered on or after 08/01/12 under the Expanded Women’s Preventive Health Mandate, refer to the Medical Management Guideline titled Preventive Care Services. Some patients may come to your practice late in their pregnancy. For BCBS plans with a copayment, this copayment should be In this case, special monitoring or care throughout pregnancy is needed, which may require more than 13 prenatal visits. Global Maternity & Multiple Births Billing Guidelines Quick Reference Guide Global Maternity Global maternity care includes pregnancy -related antepartum care, admission to labor and delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum. What if the OB patient falls or gets a symptom unrelated to the pregnancy?Do you bill it and do you get paid for it? Chercher les emplois correspondant à Bcbs maternity billing guidelines ou embaucher sur le plus grand marché de freelance au monde avec plus de 19 millions d'emplois. Before I comment on this, let me give you the results of the survey, and describe your comments. Obstetrical/Maternity Care • All routine prenatal visits until delivery (typically 14 vis-its); for additional antepartum E&M visits that exceed the typical care due to complications refer to “Provider Billing Guidelines and Documentation” section of this policy • First prenatal visit/initial evaluation, history and physi-cal exam The Maternity Period - For billing purposes, the obstetrical period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum period (56 days after vaginal delivery and 90 days after c-section). R11 - Global Maternity Obstetric Package. Per ACOG, all services rendered by MFM are outside the global package. Some pregnant patients who come to your practice may be carrying more than one fetus. Obstetrical Billing Guidelines Obstetrical Billing Guidelines Services included in the Global OB CPT®’ Code 59400 (Vaginal delivery) or 59510 (Cesarean delivery) Note: The • following information is applicable to Plans with maternity benefits. stream If the patient had fewer than 13 encounters with the provider, your practice should contact the insurer to find out whether the insurer will honor the global package CPT code. Let’s look at each category of care in detail. Delivery and postpartum care billing. That’s what we’ll be discussing today! Use CPT Category II code 0500F. Possible billings include: In the case of a high-risk pregnancy, the mother and/or baby may be at increased risk of health problems before, during, or after delivery. Incorrectly reporting the modifier will cause the claim line to be denied. Routine maternity services are not synonymous with preventive benefit with no cost share. This is usually done during the first 12 weeks before the ACOG antepartum note is started. Contraceptive management services (insertions). In the case of maternity services furnished to Medicare eligible women, Medicare applies the physician presence requirement for both types of delivery as for other surgical procedures. CPT does not specify how the images are to be stored or how many images are required. Patient receives care from a midwife but later requires MD-level care. IMPORTANT: Complications of pregnancy such as abortion (missed/incomplete) and termination of pregnancy are not included in this list. NOTE: When a patient who is considered high risk during her pregnancy has an uncomplicated delivery with no special monitoring or other activities, it should be coded as a normal delivery according to the usual codes. R12 - Facility Routine Services, Supplies and Equipment. We provide volume discounts to solo practices. Services provided to patients as part of the Global Package fall in one of three categories. Written by. b�Hi��^�}X��"FZg����LkřR)N��XnT����4�s!��_] Sm�7J���z�>�;�ئ�cX$䧪. The global maternity allowance is a complete, one-time billing which includes all professional services for routine antepartum care, delivery services, and postpartum care. A few of you commented on the diagnosis codes that should be used. However, if the cesarean delivery is significantly more difficult, append modifier 22 to code 59510. Examples of high-risk pregnancy may include: All these conditions require a higher and closer degree of patient care than a patient with an uncomplicated pregnancy. Cigna will provide reimbursement for components of the Global Maternity/Obstetric Package when NOTE: For ICD-10-CM reporting purposes, an additional code from category Z3A.- (weeks of gestation) should ALWAYS be reported to identify specific week of pregnancy. Search for jobs related to Bcbs maternity billing guidelines or hire on the world's largest freelancing marketplace with 18m+ jobs. Pre-existing type-1 diabetes mellitus, in pregnancy, Liver and biliary tract disorders in pregnancy. Full Service for RCM or hourly services for help in billing. DO NOT bill separately for maternity components. The patient has a change of insurer during her pregnancy. Make sure your practice is following correct guidelines for reporting each CPT code. When billing for the global obstetrical package code, all services must be provided by one obstetrician, one midwife, or the same physician group practice provides all of the patient’s routine obstetric care, which includes the antepartum care, delivery, and postpartum care. When discussing maternity obstetrical care medical billing, it is crucial to understand the Global Obstetrical Package. As such, visits for a high-risk pregnancy are not considered routine. There’s a common maternity care coding and billing scenario that CPT® guidelines do not address: The patient switches insurance during the pregnancy, but keeps the same physician.