The diagnosis should support these services. E/M services for management of conditions unrelated to the pregnancy during antepartum or postpartum care.External cephalic version (turning of the baby due to malposition).Cerclage, or the insertion of a cervical dilator more than 24 hours from admission.Depending on the insurance carrier, all subsequent ultrasounds after the first three are considered bundled.Obstetric ultrasound, NST, or fetal biophysical profile.Maternal or fetal echography procedures.Examples include CBC, liver functions, HIV testing, Blood glucose testing, sexually transmitted disease screening, and antibody screening for Rubella or Hepatitis, etc.Laboratory tests (excluding routine chemical urinalysis).This is usually done during the first 12 weeks before the ACOG antepartum note is started.This confirmatory visit (amenorrhea) would be supported in conjunction with the use of ICD-10-CM diagnosis code Z32.01.Initial E/M to diagnose pregnancy if antepartum record is not initiated at this confirmatory visit.If the provider performs any of the following procedures during the pregnancy, separate billing should be done as these procedures are not included in the Global Package.
The American College of Obstetricians and Gynecologists (ACOG) has developed a list of procedures that are excluded from the global package. As such, including these procedures in the Global Package would not be appropriate for most patients and providers. The provider will receive one payment for the entire care based on the CPT code billedĬertain maternity obstetrical care procedures are either highly complex and/or not required by every patient. Individual Evaluation and Management (E&M) codes should not be billed to report maternity visits unless the patient presents for issues outside the global package for commercial payers.Īll prenatal care is considered part of the global reimbursement and is not reimbursed separately.
Each physician, nurse practitioner, or nurse midwife seeing that patient has access to the same patient record and makes entries into the record as services occur. It uses either an electronic health record (EHR) or one hard-copy patient record. Here a “physician group practice” is defined as a clinic or obstetric clinic that is under the same tax ID number. When billing for the global obstetrical package code, all services must be provided by one obstetrician, one midwife, or the same physician group practice provides all of the patient’s routine obstetric care, which includes the antepartum care, delivery, and postpartum care. These might include individual evaluation and management codes, antepartum care only, delivery only, postpartum care only, delivery and postpartum care, etc. If the services rendered do not meet the requirements for a total obstetric package, the coder is instructed to use appropriate stand-alone codes. Most insurance carriers like Blue Cross Blue Shield, United Healthcare, and Aetna reimburses providers based on the global maternity codes for services provided during the maternity period for uncomplicated pregnancies.Ĭurrently, global obstetrical care is defined by the AMA CPT as “uncomplicated maternity cases which include antepartum, delivery, and postpartum care.” (Source: AMA CPT codebook 2023, page 442.) When discussing maternity obstetrical care medical billing, it is crucial to understand the Global Obstetrical Package.
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