• 1.  Postpartum inpatient billing

    Posted 12-08-2021 12:48
    Good morning. In my practice, MFM consultants do postpartum rounds on our own MFM patients (diabetics, PPROM, etc). Generally it is routine care, but many need insulin adjustment, postop care and other interventions. Is this something we should be billing for? Many of us have not been billing for these inpatients as it is "part of the OB package." 
    Feedback is appreciated.
    Thank you.

    Layan Alrahmani

  • 2.  RE: Postpartum inpatient billing

    Posted 12-08-2021 17:57
    Whether something is global or not is dependent upon the contract.  Nonetheless, it has been recommended via the SMFM that billing for MFM services be fee for service at the present time as our cases are not low-risk and require more comprehensive care.   I would think that most MFMs would agree that you should bill for these visits.  Just because the care is simple for an MFM does not mean it is not at-risk care and is only simple due to your expertise.  Hence, you should generally bill these services.

    Brian Iriye

  • 3.  RE: Postpartum inpatient billing

    Posted 12-09-2021 08:51
    Hello Layan,
    The global OB care includes only routine care. The visits you describe while inpatient are outside of the normal care of pregnancy and can be billed separately with modifier -25 (before delivery) or modifier -24 (> 24 hours after delivery) to indicate to the payer that these visits are not part of the routine global OB care for that pregnancy. As always, all the elements of the CPT code billed must be met.

    Fadi BSAT, MD, FAIUM
    Past Chair, SMFM Coding Committee