Q&A: Reporting global maternity care for pregnant patients who change facilities

October 5, 2018
Medicare Web

Q: Can I bill a global surgical package for a patient who transferred from another practice very early in her pregnancy? She is 13 weeks pregnant. I want to bill for a global visit, but my boss said we can’t do that—we must unbundle the services. Is my boss correct?

A: According to the American College of Obstetricians and Gynecologists (ACOG), if any antepartum care was administered by another provider in a different practice, that global package cannot be reported— it must be unbundled.

CPT guidelines allow for the unbundling of these services; however, if the patient transferred in from a family practice area to an OB/GYN and the family practice physician did not provide any antepartum pregnancy care (i.e., he or she was only seeing the patient for family practice issues), then yes, you could potentially bill a global visit. You would need to ascertain from the family practice or the referring provider if the previous facility provided any maternity care to that patient before she arrived at your OB/GYN facility.

Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS ambassador/trainer is an E/M, and procedure-based coding, compliance, data charge entry and HIPAA privacy specialist in Melba, Idaho. She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information at http://lori-lynnescodingcoachblog.blogspot.com/

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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