This is not a simple answer given the various intricacies of shared billing/shared care models. There are many iterations of care that MFMs provide that do not fit the traditional global ob care packages. If the MFM provides ALL the obstetric care (antepartum, delivery, postpartum) then billing a global fee is appropriate. With global billing, any E/M visits beyond the standard number of visits allotted in the global code by that payer (typically 13 visits but may vary) would then be reported separately using the diagnosis(es) that necessitated the additional visits. It would be duplicate billing to report routine antepartum E/M services separately and also report the global code.
In general, most MFM groups do NOT bill global services based on the pathway of referral into their practice. They are NOT performing all the care. It becomes particularly complicated when some of the care is provided by the Ob provider and some of the care by an MFM provider:
a) One option is to bill global and split the revenue internally after the fact - this may work if you are an MFM who works in a group or shared group model with OBs.
b) In situations where the general ob provider reports some of the antepartum care (and NO delivery) they would report the appropriate antepartum care only code; and the MFM would report the appropriate antepartum care only code for their portion and then in addition they would add the delivery and postpartum care code (59425/59426) In this scenario no one is billing a global fee.
c) MFM's may also opt to bill directly and separately for their services (Fee for Service). It is important to emphasize that this is very payer/contract dependent. The landscape has changed dramatically over the last decade. Traditionally, the SMFM Coding committee has favored E/M billing, but we acknowledge it has become increasingly difficult to negotiate with payers to allow E/M billing outside of global (unless you are over the threshold number of visits). The usual E&M services and guidelines would apply. With this option, the MFM billing should include the taxonomy code of MFM (207VM0101X), rather than OB (207V00000X).
I have a follow up question regarding maternal transports. In my previous practice if the mfm did the delivery only for a maternal transport we would bill a delivery only code (59409) with no post partum care. The referring physician would bill for antepartum and post partum 59430 if they did all the outpatient post partum follow up visits.
if our practice did the delivery and outpatient postpartum follow up including the 6 week post partum we would bill 59410.
my current practice and coding department is billing 59410 for delivery with inpatient post partum care. Then billing additional 59430 if We do the Outpatient post partum visit. If the referring doc does the outpatient post partum follow up and billing 59430 my coders are still billing 59410 for our delivery / inpatient care. Could you please clarify for me what are the correct codes for these scenarios?
thank you,Amie Hollard