Coding

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Global OB for MFM patients

  • 1.  Global OB for MFM patients

    Posted 01-15-2020 19:39
    I recently started in a new large hospital system.  They are billing global OB for high risk MFM patients except for initial consults.  I have always billed E-M outside for each visit and have never had an issue.  Is this a local issue or national?

    If you are billing global for complex patients, what do your contracts include in the global package?

    Thanks

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    Debra Guinn
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  • 2.  RE: Global OB for MFM patients

    Posted 01-17-2020 05:24
      |   view attached
    Hello
    Thanks for posting. We do not personally bill Global, as you a large majority of MFM practices are consult only - which means the most efficient manner to bill would be separate E/M with your encounter for the ultrasound or medical issue you are co-managing.  There are practices who provide total perinatal care and do bill the global - hopefully someone will reach out to you hear with how they are doing it.  We also have a coding tip on billing global services in pregnancy:
    Services Billable outside of the Global - December 2018 - I'm attaching it here

    Also, when I was reading your email, I just wanted to make sure you weren't asking more so about an episodes of care contract?  Where there are certain high risk conditions that your payer is asking be included in your 'pregnancy' fee/episode?  I wasn't sure if that's what you meant when you said "what is included"?

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    Vanita Jain
    Chair, SMFM Coding Committee
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  • 3.  RE: Global OB for MFM patients

    Posted 01-17-2020 10:16
    At our university-based practice, they do a similar thing. First visit is usually a consult, then after a transfer of care, it is billed as global. Of course, the global fee was meant to cover a range of complication, not the normal MFM patient mix that are all complicated patients. The problem with E&M’s, other than having to negotiate with the insurers, is that patients will have co-pays for every visit. So as a way to compromise, if we are actively managing some pre-pregnancy issue (eg, changing insulin in a pre-preg diabetic, checking TSH or changing med dosing in a hypothyroid patient), then with those visits, we note in our documentation that 2 separately identifiable E&M’s occurred, the first being the prenatal visit and the 2nd being the management of a prepregnancy condition. That way the visit counts towards the global count and a separate E&M is billed (usually 10-minute time code based) with a -25 modifier (for separately identifiable E&M). While there may be a co-pay associated with that, the extra E&M isn’t charged with every prenatal visit, just one where we are actually doing something extra. Personally, it would be easier to just bill one E&M for the whole visit as was taught in the SMFM coding course I took back in 2001 or so, but that isn’t the practice that developed were I am now.




  • 4.  RE: Global OB for MFM patients

    Posted 01-17-2020 11:58
    Billing global or "per visit" depends on the complexity of your patients and your payer contracts. Some payers may mandate global billing which would include 12-15 prenatal visits, delivery, and postpartum care. All visits above that limit and other visits unrelated to the care of a normal pregnancy may be billed in addition to global. It is impossible to generalize one rule because different payers may have different contracting details on what is or is not included. Imaging studies are typically not included though some practices have "adopted" OB bundle models that may include some imaging and labwork.

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    Fadi Bsat, MD
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