Learn When to Start the Global OB Package
Learn when to start the Global OB package to avoid billing errors. Understand key scenarios for accurate coding and how to handle pregnancy diagnosis during exams.
OB/GYN Medical Billing & Coding Alert
Here’s why it may be better to wait until your next full visit to learn when to start the Global OB package.
With the growing number of new coders, refreshing your knowledge on when to begin the global obstetric package can help prevent denials. The next time an OB/GYN identifies a pregnancy during a routine annual visit, you'll be prepared to take the right steps.
Rule of Thumb: In most cases, you should wait until the next full visit to begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618), according to coding experts.
How to Handle Pregnancy Diagnosed During an Annual Exam?
As you're likely aware, annual visits can confuse when it comes to diagnosing pregnancy. Do you know how to handle these situations properly?
You should select from various evaluation and management (E/M) codes depending on the specific scenario:
- If the pregnancy is diagnosed during the annual visit.
- If the patient arrives already aware of her pregnancy.
- If the OBGYN rules out other possible diagnoses.
Scenario 1: Pregnancy Diagnosed During Annual Exam
Suppose the OB/GYN diagnoses a pregnancy (Z32.01, Encounter for a pregnancy test, result positive) during a patient’s annual exam (99384-99386 for new patients or 99394-99396 for established patients). In that case, the annual examination can still be reported.
However, it's important to link the pregnancy diagnosis to the diagnostic test (e.g., 81025, Urine pregnancy test, by visual color comparison methods).
The key point is that you should wait to initiate the OB record until the next visit. Starting the OB record prematurely could result in insurance carriers considering the entire visit part of the global OB service.
Scenario 2: Patient Already Knows She Is Pregnant
Suppose a patient comes in for her annual examination already knowing she is pregnant. In that case, the physician may choose to skip the annual exam depending on how far along the pregnancy is. In this case, you should code the visit as a low-level service (for example, 99212, Office or another outpatient visit...) to confirm the pregnancy (using the appropriate test code, such as 81025). Be sure to link the diagnosis code (V72.42) to both the pregnancy test and the visit code.
If the physician decides to proceed with the annual exam, the coding will follow the approach outlined in Scenario 1.
After this visit, the patient will schedule a full visit with the OB/GYN, at which point global care will officially begin. All visits, including the initial encounter, count toward the total for global care, which typically includes 13 outpatient antepartum visits.
Scenario 3: Patient Presents with Other Complaints and Pregnancy Is Discovered
Suppose a patient comes in for her annual exam but presents with other complaints, and the OB/GYN discovers the pregnancy during the visit. In that case, the work involved in ruling out other possible diagnoses may warrant a higher-level E/M service (such as 99214, Office or other outpatient visit).
Alternatively, if properly documented, it may be coded as an annual exam with an additional problem-focused E/M service.
In this scenario, the work performed would not be focused on or related to the pregnancy except to confirm it with a pregnancy test (e.g., 81025). Therefore, if the OB/GYN identifies additional diagnoses alongside the pregnancy, those should be included as part of the E/M service.
The pregnancy diagnosis (Z32.01) would support the need for the pregnancy test, but any other diagnoses made during the visit should be addressed accordingly in the service coding.
How to Code Pregnancy Diagnosed During a Nonscheduled Visit?
Similar rules apply when a patient sees her OBGYN for a nonannual examination visit.
Scenario 1: Pregnancy Diagnosed After Evaluation for Other Symptoms
If a patient visits her OBGYN for symptoms such as abdominal cramping, sweating, missed periods, or other related complaints, which prompt the OBGYN to order a pregnancy test (e.g., 81025), and the results reveal that the patient is pregnant, you should report an E/M service. This is because the symptoms were related to a problem (such as cramping or missed periods) that ultimately turned out to be pregnancy.
If the OB/GYN evaluated other potential diagnoses that led to the pregnancy's discovery, you should report this service outside the global OB package.
You should still report the pregnancy code (Z32.01) by attaching it to the pregnancy test, but be sure that the claim clearly indicates that the OB/GYN did not see the patient for pregnancy care. The visit was to address other symptoms that prompted the pregnancy test.
Scenario 2: Patient Suspects Pregnancy and Seeks Confirmation
If a patient comes in with complaints and believes she might be pregnant, the OBGYN will assess whether these symptoms are related to pregnancy.
Suppose the complaints are determined to be related to pregnancy (e.g., a positive pregnancy test conducted during the visit), and the OBGYN either initiates the OB record during the visit or confirms the pregnancy with an ultrasound. In that case, you should code the service as part of the global OB package.
In this case, if the patient's chief complaint is related to pregnancy (such as symptoms directly linked to being pregnant), the OB record begins. Once the OB/GYN initiates the OB record during the visit, the entire visit falls under the global period for OB care.
Scenario 3: Patient Arrives Knowing She Is Pregnant Due to Home Pregnancy Test
If a patient arrives knowing she is pregnant because her home pregnancy test was positive and the OB/GYN simply "confirms the confirmation," you should code the service based on the method used to confirm the pregnancy. This could include using a urine pregnancy test (81025) if the OBGYN performs one or a low-level E/M service if the patient discusses the pregnancy.
However, suppose the service provided includes a thorough discussion of pregnancy care. In that case, most payers will consider this the initiation of global OB care, meaning the visit would be treated as part of the global period.
Note: Many practices do not accept home pregnancy tests and may require the patient to obtain confirmation from their primary care physician or another medical provider before proceeding with OB care.
BillingFreedom is Your Trusted Partner for OBGYN Medical Billing Services
BillingFreedom is the best resource for OBGYN Medical Billing Services due to our in-depth expertise in handling complex billing scenarios, including those discussed above. We excel in accurately managing the start of the global obstetric package, preventing denials for premature OB record initiation, and ensuring proper documentation for annual and non-annual visits.
Whether diagnosing pregnancy during an annual exam, confirming pregnancy in a nonscheduled visit, handling included postpartum exams, or navigating Modifier 52 For Incomplete or Partial Delivery, our team is equipped to navigate all aspects of obstetric coding and documentation.
With mastery in OBGYN coding, including guidance on postpartum exams and the nuances of global record initiation, BillingFreedom guarantees precision, compliance, and optimal reimbursement for your practice.
For more details about our exceptional medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.
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