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Understanding the Global Obstetrical Package

June 23, 2020 | By Grant Huang , CPC, CPMA

One of the more challenging aspects of coding and auditing for OB/GYN providers revolves around the global obstetrical package, which bundles all services relating to pregnancy and delivery into a single global code, depending on the manner of delivery.

What is part of the global package? What isn’t? When is it appropriate to unbundle parts of the package, and how do the rules differ based the payer? We will explore some of these questions in this audit tip, which will be a refresher for some OB/GYN auditors and hopefully more informative for others.

Contents of the global OB package

Broadly speaking, the global OB package covers routine maternity services, dividing the pregnancy into three stages: antepartum (also known as prenatal) care, delivery services, and postpartum care.

  Antepartum care refers to the serious routine, regular obstetrical visits that are spread out during the 40 weeks of a typical pregnancy. These visits include performing a prenatal history and physical exam of the mother, identifying all medical factors that could affect the health of the baby and the difficulty of delivery. This phase of care also includes all the routine, regularly performed tests to monitor the development of the baby.

Delivery services include the mother’s admission to the hospital for birthing, the admission history and physical exam, management of labor, and either vaginal or cesarean delivery of the baby. The global package covers an uncomplicated delivery, so any significant complications of labor and delivery are separately billable if supported by appropriate documentation.

Postpartum care covers outpatient visits for a period of six weeks following delivery, during which the provider manages the acute effects of labor and delivery in the mother while also monitoring her general postpartum health

What’s covered and what’s not

The global OB package is designed to include the evaluation and management of common complications of pregnancy, including any of the mother’s chronic conditions that would affect the pregnancy. Here’s a list of what is typically inclusive:

• Routine prenatal visits (13 total for uncomplicated pregnancies), which include initial and subsequent history, physical exams, and recording of weight, blood pressure, and fetal heart tones
• Routine urinalysis
• Hospital admission, including H&P, prior to delivery
• Management of uncomplicated labor
• Delivery, either vaginal or via cesarean section
• Delivery of placenta
• Routine outpatient office visits within 6 weeks of delivery, including to provide education on breastfeed, newborn care, lactation, contraceptive management

What is not inclusive and can be separately billed :

• The initial office visit to diagnose or confirm pregnancy is not considered part of the global package
• Complications of pregnancy resulting in more than the usual number (13) of prenatal visits are billed separately
• Any E&M visit for an OB/GYN purpose that is unrelated to the pregnancy
• Laboratory tests beyond the routine urinalysis
• Fetal contraction stress tests and fetal non-stress tests
• Obstetrical ultrasounds (though an E&M visit is not separately billable unless modifier 25 requirements are met)
• Management of surgical complications during pregnancy

Note that some of these particulars may vary by payer, and that some payers (including state Medicaid plans) do not use the global package at all, and instead separately reimburse all of these services.

Unbundling or splitting the OB package

There are several scenarios that would result in the necessary unbundling (also called “splitting” or “itemizing”) of the OB package. They are as follows:

• The patient transfers into or out of a practice, or the patient changes to another obstetrician during pregnancy (from a separate practice under a separate tax ID)
• Different and unrelated providers perform different parts of the pregnancy (e.g. a hospitalist delivers the baby in a case where the baby comes early, and the obstetrician doesn’t arrive in time)
• The patient changes insurance plans during the pregnancy
• The patient terminates pregnancy or miscarries

As mentioned earlier, there are significant payer-level differences on some of these items, especially when it comes to coding. When it comes to the global obstetrical package, looking up your payer’s specific policies is of paramount importance, probably more so than for many other areas of coding and auditing.

OnDemand Webinar

For a comprehensive guide to the global obstetrical package, including details on CPT and ICD-10 coding as well as a discussion of payer-specific policies and payers that do not use the global package, please visit http://shop.namas.co/Specialty-Auditing-OBGYN-Understanding-the-Global-OB-Package_p_522.html to purchase my webinar “The Global Obstetrical Package,”

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Challenges of OB/GYN Billing

OB/GYN billing and coding always has been a challenge for most of billers and coders due to the global claims, widely varying coverage terms, and multiple tests performed at numerous facilities. Apart from this, many OB/GYN practitioners lack the billing support provided to large hospitals. As Pregnancy coverage includes inpatient and outpatient services, billers are not aware how to split between them.

Accurate OB/GYN billing requires a clear understanding of the criterion that determines the ‘medical necessity’ to code for the various levels of ground and air ambulance services used. Most billers are not aware of pregnancy coverage and various billing updates to an existing insurance plan. Most healthcare organization loses money as they overlook separately billable services rendered during the global period. In this article, we focussed on accurately billing global obstetrical package which will help you to reduce claim denials.

Billing Global Obstetrical Package

Defining the global obstetrical package.

Before we proceed with billing the global obstetrical package, let's understand what includes the global obstetrical package. As defined by the American Medical Association (AMA), ‘the total obstetric package includes the provision of antepartum care, delivery, and postpartum care.’ When the Same Group Physician and/or Other Health Care Professional provides all components of the OB package, report the global OB package code.

• Antepartum care refers to the serious routine, regular obstetrical visits that are spread out during the 40 weeks of a typical pregnancy. These visits include performing a prenatal history and physical exam of the mother, identifying all medical factors that could affect the health of the baby, and the difficulty of the delivery. This phase of care also includes all the routine, regularly performed tests to monitor the development of the baby.
• Delivery services include the mother’s admission to the hospital for birthing, the admission history and physical exam, management of labor, and either vaginal or cesarean delivery of the baby. The global package covers an uncomplicated delivery, so any significant complications of labor and delivery are separately billable if supported by appropriate documentation.
• Postpartum care covers outpatient visits for a period of six weeks following delivery, during which the provider manages the acute effects of labor and delivery in the mother while also monitoring her general postpartum health.

Contents of Global Obstetrical Package

The Current Procedural Terminology (CPT®) book identifies the global OB codes as: 59400, 59510, 59610, and 59618.

Services Included in the Global OB Package

• All routine prenatal visits until delivery (approximately 13 for uncomplicated cases)
• Initial and subsequent history and physical exams
• Recording of weight, blood pressures, and fetal heart tones
• Routine chemical urinalysis (CPT codes 81000 and 81002)
• Admission to the hospital including history and physical
• Inpatient Evaluation and Management (E/M) service provided within 24 hours of delivery
• Management of uncomplicated labor
• Vaginal or cesarean section delivery (limited to single gestation)
• Delivery of placenta
• Administration/induction of intravenous oxytocin
• Insertion of a cervical dilator on the same date as delivery
• Repair of first- or second-degree lacerations
• A simple removal of cerclage (not under anesthesia)
• Uncomplicated inpatient visits following delivery
• Routine outpatient E/M services provided within 6 weeks of delivery
• Postpartum care only
• Educational services e.g., breastfeeding, lactation, and basic newborn care

Services Excluded from the Global OB Package

• Initial E/M to diagnose pregnancy if the antepartum record is not initiated at this confirmatory visit. This confirmatory visit would be supported in conjunction with the use of ICD-10-CM diagnosis code Z32.01.
• Laboratory tests (excluding routine chemical urinalysis)
• Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828).
• Amniocentesis, any method
• Amnioinfusion
• Chorionic villus sampling (CVS)
• Fetal contraction stress test
• Fetal non-stress test
• External cephalic version
• Insertion of cervical dilator more than 24 hours before delivery
• E/M services for the management of conditions unrelated to the pregnancy (e.g., bronchitis, asthma, urinary tract infection) during antepartum or postpartum care; the diagnosis should support these services.
• Additional E/M visits for complications or high-risk monitoring resulting in greater than the typical 13 antepartum visits;
• Inpatient E/M services provided more than 24 hours before delivery.
• Critical care services that are unrelated to the specific anatomic injury or general surgical procedure performed, within a global surgical period.
• Management of surgical problems arising during pregnancy (e.g., appendicitis, ruptured uterus, cholecystectomy)

Global Obstetrical Package (59400, 59510, 59610, 59618)

Separate reimbursements for services provided during the pregnancy that are included in the global obstetrical package for uncomplicated maternity cases are not allowed. The provider can only bill for the global obstetrical delivery if the same physician began routine antepartum care prior to the 28th week of gestation and continued care through the delivery and postpartum period, the physician must bill the appropriate code for total obstetrical care.

Global Obstetrical Delivery Post-Operative Care (59410, 59515, 59614, 59622)

Evaluation and Management services and postpartum care billed for a date of service within a 42-day time frame will bundle into the global delivery service when billed by the same provider performing the delivery service, except when the E&M is unrelated to the obstetrical care or is related to a maternity complication.

Antepartum Care (59425 and 59426)

It is not appropriate for a single provider to bill more than one 59425 or 59426 in any combination during the antepartum period. If more than one of the Antepartum Care codes is billed by the same provider in a 240-day period, the subsequent billed codes will be denied.

Delivery Only (59409, 59514, 59612, 59620) Per the CPT book, ‘Delivery services include admission to the hospital, the admission history and physical examination, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery.’

Antepartum Care by Different Provider Groups

When more than one provider group renders a portion of the antepartum care to a pregnant patient, it is inappropriate for the delivering physician to bill with a global obstetrical delivery code. The provider can only bill for the global obstetrical delivery if the same physician began routine antepartum care prior to the 28th week of gestation and continued care through the delivery and postpartum period.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services . We referred various payer reimbursement policies and shared detailed information on billing global obstetrical package. You can refer payer specific billing and coding guidelines for accurate insurance coverage for the global obstetrical package.

You can refer our OB/GYN billing services to reduce claim denials and to receive accurate insurance collections. To know more about our OB/GYN billing and coding services, email us at: [email protected] or call us: 888-357-3226 .

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Maternity Obstetrical Care Medical Billing & Coding Guide for 2024

Coding and billing for maternity obstetrical care is quite a bit different from other sections of the American Medical Association Current Procedural Terminology (CPT).

Maternity care services typically include antepartum care, delivery services, as well as postpartum care. Depending on the patient’s circumstances and insurance carrier, the provider can either:  

• Submit all rendered services for the entire nine months of services on one CMS-1500 claim form for full term deliveries for most private payers including Medicare.  
• Submit claims based on an itemization of maternity care services. (e.g., most state Medicaid payers require claim submission per visit.)  

Let us discuss what you need to know about maternity obstetrical care medical billing.  

Maternity Obstetrical Care Medical Billing & Coding Guide for 2024

This article explores the key aspects of maternity obstetrical care medical billing and breaks down the vital information your OB/GYN practice needs to know. We will go over:  

• Different types of services rendered  
• The global maternity care package: what services are included and excluded?  
• The split OB packages  
• Complications of pregnancy  
• High-risk patients  
• CPT definitions  
• And much more  

Finally, always be aware that individual insurance carriers provide additional information such as modifier use.  

We hope that this guide will assist you in maternity obstetrical care medical billing and coding for your practice. For more details on specific services and codes, see below.  

Table of Contents

The Global Obstetrical Package

When discussing maternity obstetrical care medical billing, it is crucial to understand the Global Obstetrical Package .  

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.

Currently, global obstetrical care is defined by the AMA CPT as “uncomplicated maternity cases which include antepartum, delivery, and postpartum care.” (Source: AMA CPT codebook 2024, page 450.)

If the services rendered do not meet the requirements for a total obstetric package, the coder is instructed to use appropriate stand-alone codes. These might include individual evaluation and management codes, antepartum care only, delivery only, postpartum care only, delivery and postpartum care, etc.

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 the patient’s routine obstetric care, which includes the antepartum care, delivery, and postpartum care.

Here a “physician group practice” is defined as a clinic or obstetric clinic that is under the same tax ID number . It uses either an electronic health record (EHR) or one hard-copy patient record. 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.

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.  

All prenatal care is considered part of the global reimbursement and is not reimbursed separately. The provider will receive one payment for the entire care based on the CPT code billed  

Services Bundled with the Global Obstetrical Package

A key part of maternity obstetrical care medical billing is understanding what is and is not included in the Global Package.  

Services provided to patients as part of the Global Package fall in one of three categories. They are:  

• Antepartum care: Care given from conception, up to (not including) the delivery of the fetus.  
• Intrapartum care: Inpatient care of the passage of the fetus and placenta from the womb.  
• Postpartum care: Care of the mother after delivery of the fetus.  

Let us look at each category of care in detail.

Antepartum Care

Antepartum care comprises the initial prenatal history and examination, as well as subsequent prenatal history and physical examination. This includes:

• Monthly visits up to 28 weeks of gestation
• Biweekly visits up to 36 weeks of gestation
• Weekly visits from 36 weeks until delivery
• Recording of weight, blood pressures and fetal heart tones
• Routine chemical urinalysis (CPT codes 81000 and 81002)
• Education on breast feeding, lactation and pregnancy (Medicaid patients)
• Exercise consultation or nutrition counseling during pregnancy

IMPORTANT: Any other unrelated visits or services within this time period should be coded separately. Example: patient comes in with the flu for this visit a E/M visit should be used.  

Intrapartum Care AKA Labor & Delivery

• Admission to the hospital including history and physical.  
• Inpatient evaluation and management (E/M) services provided within 24 hours of delivery.  
• Management and fetal monitoring of uncomplicated labor  
• Administration/induction of intravenous oxytocin (performed by provider not anesthesiologist)  
• Insertion of cervical dilator on same date as delivery, placement catheterization or catheter insertion, artificial rupture of membranes  
• Removal of cerclage (if removed under anesthesia other than “local” it is a billable procedure)  
• Vaginal, cesarean section delivery, delivery of placenta only (the operative report)  

Postpartum Care

• Uncomplicated inpatient visits following delivery.  
• Repair of first- or second-degree lacerations (for lacerations of the third or fourth degree, see “Services Bundled into Global Obstetrical Package”)  
• Simple removal of cerclage (not under anesthesia)  
• Routine outpatient E/M services that are provided within 6 weeks of delivery (check insurance guidelines for exact postpartum period)  
• Discussion of contraception prior to discharge  
• Outpatient postpartum care – Comprehensive office visit  
• Educational services, such as breastfeeding, lactation, and basic newborn care  
• Uncomplicated treatments and care of nipple problems and/or infection  

Services Excluded from the Global Obstetrical Package

Certain maternity obstetrical care procedures are either overly complex and/or not required by every patient. As such, including these procedures in the Global Package would not be appropriate for most patients and providers. The American College of Obstetricians and Gynecologists (ACOG) has developed a list of procedures that are excluded from the global package. 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.  

• This confirmatory visit (amenorrhea) would be supported in conjunction with the use of ICD-10-CM diagnosis code Z32.01.
• This is usually done during the first 12 weeks before the ACOG antepartum note is started. Use CPT Category II code 0500F.
• Examples include CBC, liver functions, HIV testing, Blood glucose testing, sexually transmitted disease screening, and antibody screening for Rubella or Hepatitis, etc.
• Maternal or fetal echography procedures
• Depending on the insurance carrier, all subsequent ultrasounds after the first three are considered bundled
• Cerclage, or the insertion of a cervical dilator more than 24 hours from admission.
• External cephalic version (turning of the baby due to malposition)
• Amniocentesis (any method)
• Amnioinfusion
• Chorionic villus sampling (CVS)
• Fetal contraction stress test
• Examples include cardiac problems, neurological problems, diabetes, hypertension, hyperemesis, preterm labor, bronchitis, asthma, and urinary tract infection
• NOTE: These encounters could be office visits, clinic visits, emergency room, or inpatient admission/observation.
• Inpatient E/M services provided more than 24 hours before delivery
• Examples include urinary system, nervous system, cardiovascular, etc.
• Per ACOG coding guidelines, this should be reported using modifier 22 of the CPT code used to bill.
• Contraceptive management services (insertions)

List of CPT Codes

The AMA categorizes Maternity care and delivery CPT codes. The following is a comprehensive list of all CPT codes for full term pregnant women.  

IMPORTANT: Complications of pregnancy such as abortion (missed/incomplete) and termination of pregnancy are not included in this list.  

The following codes can also be found in the 2024 CPT codebook.  

Description

Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

Global Package Code Vaginal Delivery

Vaginal delivery only (with or without episiotomy and/or forceps);

Itemization Code

Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care

Antepartum care only; 1-3 visits

Antepartum care only; 4-6 visits

Antepartum care only; 7 or more visits

Postpartum care only (separate procedure)

Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

Global Package Code C-Section Delivery

Cesarean delivery only;

Cesarean delivery only; including postpartum care

Global Package Code VBAC Delivery

Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);

Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care

Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care

Maternity Obstetrical Care Medical Billing for Twin Delivery/Multiple Gestation

Some pregnant patients who come to your practice may be carrying more than one fetus. In such cases, certain additional CPT codes must be used.

ACOG has provided the following coding guidelines for vaginal, cesarean section, or a combination of vaginal and cesarean section deliveries.  

To ensure accurate maternity obstetrical care medical billing and timely reimbursements for work performed, make sure your practice reports the proper CPT codes.  

Type of Service/Procedure

Type of twin, cpt codes reported.

Vaginal Delivery of Twins

C-Section Delivery of Twins

Twin A & Twin B

Repeat Cesarean Delivery

Delivery of Twins

VBAC Delivery of Twins

Vaginal & C-Section Delivery of Twins

VBAC + repeat Cesarean Delivery of Twins

If both twins are delivered via cesarean delivery, report code 59510 (routine obstetric care including antepartum care, cesarean delivery, and postpartum care). This is because only one cesarean delivery is performed in this case.

However, if the cesarean delivery is significantly more difficult, append modifier 22 to code 59510. When reporting modifier 22 with 59510, a copy of the operative report should be submitted to the insurance carrier with the claim.

Split Care Performed/Itemization Billing

Some patients may come to your practice late in their pregnancy. Others may elope from your practice before receiving the full maternal care package. In such cases, your practice will have to split the services that were performed and bill them out as is. Examples of situations include:  

• The patient has received part of her antenatal care somewhere else (e.g. from another group practice).
• The patient leaves her care with your group practice before the global OB care is complete.
• Patient receives care from a midwife but later requires MD-level care.
• The patient has a change of insurer during her pregnancy.

In these situations, your practice should contact the insurance carrier and notify them of these changes. This will allow reimbursement for services rendered . If the patient has fewer than 13 encounters with the provider, your practice should contact the insurer to find out whether the insurer will honor the global package CPT code. Billings include:  

• 59425: Antepartum care only, 4-6 visits
• 59426: Antepartum care only, 7 or more visits; E/M visit if only providing 1-3 visits
• Delivery only: CPT codes 59409, 59514, 59612, and 59620
• Postpartum care only: CPT code 59430

Maternity Obstetrical Care Medical Billing for High-Risk Pregnancies

In the case of a high-risk pregnancy, the mother and/or baby may be at increased risk of health problems before, during, or after delivery. In this case, special monitoring or care throughout pregnancy is needed, which may require more than 13 prenatal visits.

Examples of high-risk pregnancy may include:

• Advanced maternal age: pregnancy risks rise for mothers past the age of 35.
• Maternal health problems: pre-gestation medical complication such as hypertension, diabetes, epilepsy, thyroid disease, heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risk.
• Pregnancy-Related Complications: examples include gestation, diabetes and/or hypertension, poor fetal growth, premature rupture of membrane, abnormal placenta position, etc.

All these conditions require a higher and closer degree of patient care than a patient with an uncomplicated pregnancy.

As such, visits for a high-risk pregnancy are not considered routine. They should be reported in addition to the global OB CPT codes of 59400, 59510, 59610 or 59618.

If medical necessity is met, the provider may report additional E/M codes, along with modifier 25, to indicate that care provided is significant and separate from routine antepartum care. The claim should be submitted with an appropriate high-risk or complicated diagnosis code.

Examples of applicable ICD-10-CM codes:

Supervision of other high-risk pregnancies

Pre-existing hypertensive heart disease complicating pregnancy

Pre-existing hypertension with pre-eclampsia

Gestational [pregnancy-induced] edema and proteinuria without hypertension

Pre-eclampsia

Pre-existing type-1 diabetes mellitus, in pregnancy, childbirth, and the puerperium

Liver and biliary tract disorders in pregnancy, childbirth, and the puerperium

Anemia complicating pregnancy, childbirth, and the puerperium

NOTE: When a patient who is considered high risk during her pregnancy has an uncomplicated delivery with no special monitoring or other activities, it should be coded as a normal delivery according to ICD-10-CM guidelines.  

Maternal-Fetal Medicine (MFM) Care

Maternal-fetal medicine specialists, also known as perinatologists , are physicians who subspecialize within the field of obstetrics. They focus on managing the health concerns of the mother and fetus prior to, during, and shortly after pregnancy.  

Per ACOG, all services rendered by MFM are outside the global package. Unless the patient sees the provider during their entire pregnancy then a global package is appropriate . An MFM is allowed to bill for E/M services along with any procedures performed (such as ultrasounds, fetal doppler, etc.) with a modifier 25.

Make sure you double check all insurance guidelines to see how MFM services should be reported if the provider and MFM are within the same group practice.

Ultrasound Billing

When reporting ultrasound procedures, it is crucial to adhere closely to maternity obstetrical care medical billing and coding guidelines.

It is necessary to keep a written report from the provider and have images stored on file . As per AMA CPT and ultrasound documentation requirements, image retention is mandatory for all diagnostic and procedure guidance ultrasounds.

Appropriate image(s) and reports demonstrating relevant anatomy/pathology for each procedure coded should be retained and available for review. CPT does not specify how the images should be stored or how many images are required . However, in your documentation the provider should document where to find the images and report.  

Modifiers may be applicable if there is more than one fetus and multiple distinct procedures performed at the same encounter. Incorrectly reporting the modifier will cause the claim line to be denied.

The following CPT codes cover ranges of several types of ultrasound recordings that might be performed. Make sure your practice follows correct guidelines for reporting each CPT code.  

• 76801–76810: maternal and fetal evaluation (transabdominal approach, by trimester)
• 76811–76812: above and detailed fetal anatomical evaluation
• 76813–76814: fetal nuchal translucency measurement
• 76815: limited trans-abdominal ultrasound study
• 76816: follow-up trans-abdominal ultrasound study
• 76817: trans-vaginal ultrasound study
• 76818–76819: fetal biophysical profile
• 59025: fetal non-stress test

It is essential to read all the parenthetical guidelines that instruct the coder on how to properly bill the service for multiple gestations and more than one type of ultrasound.

Trimesters of Pregnancy

• 1 st trimester: less than 14 weeks 0 days
• 2 nd trimester: 14 weeks 0 days, to less than 28 weeks 0 days
• 3 rd trimester: 28 weeks 0 days, to delivery

NOTE: For ICD-10-CM reporting purposes, an additional code from category Z3A.- (weeks of gestation) should ALWAYS be reported to identify the specific week of pregnancy. (e.g., 15-week gestation is reported by Z3A.15).  

Diagnosis Codes for Deliveries and Related Services

• Reporting Routine Prenatal Visits: routine prenatal visits are reported with a code from category Z34.- It should always be the first-listed diagnosis code unless the patient has other medical conditions affecting the pregnancy. Note that Z34.- codes should never be reported with an O code.
• Outcome of Delivery: should be included when a delivery has occurred (ICD-10-CM Z37.-).
• If O80 is not appropriate, the primary diagnosis should reflect the main circumstances or complications of the delivery.
• If the patient is admitted with condition resulting in cesarean, then that is the primary diagnosis.
• If admitted for other reason, the admitting diagnosis is primary for admission and reason for cesarean linked to delivery.
• If multiple conditions prompted the admission, sequence the one most related to the delivery as the principal diagnosis.
• O Codes: An O code from ICD-10-CM Chapter 15 – “Pregnancy, Childbirth & the Puerperium” should always be reported for the delivery when the patient has experienced any current complication in the antepartum period, during the delivery, or in the postpartum period.
• All conditions treated or monitored can be reported (e.g., gestation diabetes, pre-eclampsia, prior C-section, anemia, GBS, etc.)

Who Is Eligible to Provide Patient Care?

The following is a comprehensive list of eligible providers of patient care (with the exception of residents, who are not billable providers):

• Obstetrician, Maternal Fetal Specialist, Fellow
• Certified Nurse Midwife (CNM)
• Nurse Practitioner Midwife (NPM)
• Certified Professional Midwife (CPM)

Depending on your state and insurance carrier (Medicaid), there may be additional modifiers necessary to report depending on the weeks of gestation in which patient delivered. Before completing maternity obstetrical care billing and coding, always make sure that the latest OB guidelines are retrieved from the insurance carrier to avoid denials or short pay.  

To ensure proper maternity obstetrical care medical billing, it is critical to look at the entire nine months of work performed to properly assign codes.  

Pay special attention to the Global OB Package. The coder should have access to the entire medical record (initial visit, antepartum progress notes, hospital admission note, intrapartum notes, delivery report, and postpartum progress note) to review what should be coded outside the global package and what can be bundled in the Global Package.  

The key is to remember to follow the CPT guidelines, correctly append diagnoses, and ensure physician documentation of the antepartum, delivery and postpartum care and amend modifier(s).  

At Neolytix, we’re here to support your practice with medical billing services for OBGYN , coding, EMR templates, and more.

Reach out to us anytime for a free consultation by completing the form below.

American College of Obstetricians and Gynecologists

• Coding for Postpartum Services (The Fourth Trimester)

Stanford Children’s Help

• Fetal Ultrasound
• From Antepartum to Postpartum

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Get your free intuitive, fast facts for maternity obstetrical care coding flash guide now.

A newsletter for contracting institutional and professional providers

August 2019

Global obstetric services: use caution to ensure proper coding on claims.

Obstetrical services are processed in accordance with Current Procedural Terminology (CPT ® ) coding guidelines. Global obstetric services fall into the following categories:

• Antepartum care (care provided prior to delivery)
• Postpartum care (care provided after delivery)

According to CPT coding guidelines, if only one physician treated a patient for an entire pregnancy, to include all antepartum care visits, delivery and ending with postpartum care, billing with a global CPT code may be appropriate.

When an obstetrical patient requires the services of two (or more) different physicians during the course of pregnancy, however, it is the responsibility of each physician to bill for services using the appropriate CPT code that accurately describes the services they performed.

Here is an example from the 2019 CPT codebook published by the American Medical Association (AMA): “If all or part of the antepartum and/or postpartum patient care is provided except delivery due to termination of pregnancy by abortion or referral to another physician or other qualified health care professional for delivery, see the antepartum and postpartum codes….”

We appreciate the care and services you provide to our members. We also appreciate your attention to careful coding to ensure services performed are accurately reported on claims.

CPT copyright 2018 AMA. All rights reserved. CPT is a registered trademark of the AMA.

This material is provided for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials.

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© Copyright 2019 Health Care Service Corporation. All Rights Reserved.

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Feature Stories

• As Mental Health Needs Continue To Rise, So Do Innovative Virtual Services As Mental Health Needs Continue To Rise, So Do Innovative Virtual Services
• Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures
• Bariatric Surgery Value-Based Program Helps Members with Weight Loss Bariatric Surgery Value-Based Program Helps Members with Weight Loss
• Dental Providers Benefit from Dedicated Horizon Liaisons Dental Providers Benefit from Dedicated Horizon Liaisons
• Connecting with parents on the importance of early childhood health screenings and vaccinations Connecting with parents on the importance of early childhood health screenings and vaccinations
• Episodes of Care Program Gives Cancer Patients the Care They Need Episodes of Care Program Gives Cancer Patients the Care They Need
• Home-Delivered Meals Help Braven Health&#8480; Patients Home-Delivered Meals Help Braven Health&#8480; Patients
• How a value-based primary care provider helps the New Jersey Vaccination Program How a value-based primary care provider helps the New Jersey Vaccination Program
• Improving Health Equity through Increased Access to Prenatal Care Across New Jersey Improving Health Equity through Increased Access to Prenatal Care Across New Jersey
• Pharmacy Collaboration leads to better patient outcomes and cost savings Pharmacy Collaboration leads to better patient outcomes and cost savings
• Providing Innovative Cancer Care - Expanding Episodes of Care Providing Innovative Cancer Care - Expanding Episodes of Care
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Update: Coverage and Reimbursement for COVID-19 Testing to change

Important information for new covid-19 vaccine claims, code terminations as the phe ends, phe update: prescription limitation change for braven health, hmo d-snp and medicare part d members, important update: additional policy changes as phe ends, some benefits changes as the phe ends, referral requirements for all services, referral requirements for services not related to covid-19, reminder: select one method for covid-19 and influenza testing, antibody testing: fda and cdc do not recommend use to determine immunity, covid-19 vaccine administration reimbursement at uccs, coverage for antibody infusion therapy, reminder to use specific codes when evaluating for covid-19, covid-19 update: telemedicine reimbursement policy addenda, our commitment, our healthcare facilities, braven health℠, horizon behavioral health℠, patient care support, claim submission & billing, inquiries, complaints & appeals, patient quality & outcome resources, provider portal, working with us: information & education resources, frequently used forms, miscellaneous, w9 form-dental, w9 form-medical, news & legal notices, provider alerts, global obstetrical reimbursement and e&m services.

Obstetrical physicians and health care professionals that bill on a global basis should submit a single claim for all services rendered during the maternity period (the 270-day term of a covered member’s pregnancy for antepartum care, delivery and postpartum care).

Our global obstetrical reimbursement, consistent with CPT® guidelines and The American College of Obstetricians and Gynecologists (ACOG), was designed and calculated based on services routinely performed during pregnancy. Individual components of the global obstetrical service should not be billed separately.

Services that are component parts of a global obstetrical service, including Evaluation and Management (E&M) services provided in either an office or inpatient place of service, that are billed independent of the submission for the global obstetrical reimbursement should be denied as inclusive to the global obstetrical reimbursement.

A recent audit of claims revealed that certain E&M services provided within the 270-day term of a covered member’s pregnancy for antepartum care, delivery and postpartum care were reimbursed in addition to the global obstetrical reimbursement we provided.

As a result, on  September 1, 2015 , we will begin adjusting certain claims for dates of service March 1, 2014 and after for which reimbursement was provided for E&M services that occurred within the 270-day term of a covered member’s pregnancy if we also provided global obstetrical reimbursement to that same practice for that patient.

On August 7, 2015 , we will enhance our claim processing system so that E&M services provided within a 270-day term of a covered member’s pregnancy will be systemically denied as inclusive services if a claim for global obstetrical reimbursement is submitted for that patient for that same pregnancy by the same practice.

If you have questions, please call Physician Services at 1-800-624-1110 , Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.

We encourage all practices to review our online Billing Guidelines for Maternity Services , which includes the following information.

It is appropriate to bill one of the following global CPT codes once for all services rendered during the maternity period of a particular patient.

59400 :  Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.

59510 :  Routine obstetric care, including antepartum care, cesarean delivery and postpartum care.

59610 :  Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery.

59618 :  Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery.

Please keep the following in mind when billing on a global basis for the care provided to an enrolled Horizon BCBSNJ member during a single maternity period.

Please DO NOT:

• Submit multiple global codes for the same pregnancy.
• Bill separately for maternity components.
• Bill separately for a delivery charge.
• Bill multiple global codes for multiple births.

CPT® is a registered trademark of the American Medical Association.

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