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.
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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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