Obstetrics and Gynecology Medical Billing – Some Key Points

Obstetrics and Gynecology Medical Billing – Some Key Points

Billing for maternity care is complex and many physicians rely on professional obstetrics and gynecology medical billing services.

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When treating pregnant women, obstetricians and gynecologists have to deal with many fetal and anatomical considerations and unexpected eventualities. All this makes obstetrics and gynecology medical billing quite challenging. Here are some key points to note to billing for this specialty. 

Reporting confirmation of pregnancy visit: One common question is whether to report the initial visit to confirm a pregnancy as an E/M visit separately from the global OB package. To code this correctly, it should be determined whether: - if the patient is there for a confirmation of pregnancy or if the pregnancy has already been confirmed, and - if the OB record has been initiated

If the patient has symptoms of pregnancy or has had a positive home pregnancy test and is visiting to confirm pregnancy, this encounter can be reported using appropriate level E/M services code. On the other hand, if OB record is initiated at this visit, then the visit cannot be billed separately and is part of the global OB package. However, the decision on initiating global OB care would depend on the clinical circumstances, the physicians’ medical evaluation, and insurance reimbursement policies. Under ICD-10-CM, the diagnostic coding options are: Z32.00 Encounter for pregnancy test, result unknown Z32.02 Encounter for pregnancy test, result negative Z32.01 Encounter for pregnancy test, result positive 

Billing for normal and ‘complicated’ pregnancy: The following CPT codes are used to report a normal, uncomplicated pregnancy: -

59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

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59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

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59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

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59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Delivery, antepartum care, and postpartum care should be reported separately using dedicated CPT codes if the physician does not perform all services described by the global codes. 

Global OB: The global obstetric (OB) code should be billed whenever one physician or physicians of the same group provide all components of the patient’s care. This includes 4 or more antepartum visits, delivery and postpartum care. The number of antepartum visits may vary from patient to patient, but if global ob care is provided, the global OB code should be used to bill all pregnancy related visits (apart from inpatient hospital visits for complications of pregnancy). Individual E/M codes should not be used to bill pregnancy related E/M visits.

Lab tests (excluding dipstick urinalysis), diagnostic ultrasound, amniocentesis, cordocentesis, chorionic villus sampling, fetal stress test, and fetal non-stress test are not considered part of global maternity services and should be billed separately.

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Broken global: This happens when the patient changes insurance during the pregnancy, but continues to see the same physician. Different insurance providers have different policies and procedures as well as antepartum codes for single and multiple births. So when a patient switches insurance, the biller should ensure adherence to payers’ individual rules. Generally, insurers will pay only for that specific portion of care for which they are responsible.

However, this rule would not apply if the patient delivers late or has several worriedwell visits from the point where she changed her insurance provider. In this case, the requirements of the new insurance might be met and global billing may be justified.

With all these complexities, it’s hardly surprising that many medical facilities are relying on obstetrics and gynecology medical billing and coding services.

Experienced medical billing and coding companies are well aware of the rules of different payers and can submit claims to ensure maximum reimbursement.

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Phone: 1-800-670-2809