Global OB Care Coding and Billing GuidelinesGlobal OB Care Coding and Billing Guidelines

By: Sheila Haynes – Coding and Compliance Manager

The total obstetric care package, commonly referred to as “Global OB Care”, includes the provision of antepartum care, delivery services and postpartum care. When the same group physician and/or other healthcare professional provides all components of the OB package, the appropriate CPT code for the Global OB care is reported.

1. CPT Codes For Global OB

  • 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.

2. OB Global Billing Guidelines

  • The global maternity allowance is a complete, one-time billing which includes all professional services for routine antepartum care, delivery services, and postpartum care.
  • The fee is reimbursed for all of the member’s obstetric care to one provider.
  • If the member is seen four or more times prior to delivery for prenatal care and the provider performs the delivery, and performs the postpartum care then the provider must bill the Global OB code.
  • Global maternity billing ends with release of care within 42 days after delivery.
  • Global OB care should be billed after the delivery date/on delivery date.

3. Services Included in Global Obstetrical Package

  • Routine prenatal visits until delivery, after the first three antepartum visits.
  • Recording of weight, blood pressures and fetal heart tones.
  • 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.
  • Delivery of placenta (CPT code 59414).
  • Administration/induction of intravenous oxytocin (CPT code 96365-96367).
  • Insertion of cervical dilator on same date as delivery (CPT code 59200).
  • Repair of first or second degree lacerations.*
  • Simple removal of cerclage (not under anesthesia).
  • Uncomplicated inpatient visits following delivery
  • Routine outpatient E/M services provided within 42 days following delivery.
  • Postpartum care after vaginal or cesarean section delivery (CPT code 59430).

The above services are not separately reimbursed when submitted separately from the global OB code.

*As per ACOG (American College of Obstetricians and Gynecologists) coding guidelines, reporting of third and fourth degree lacerations should be identified by appending modifier -22 to the global OB code (codes 59400 and 59610) or delivery only code (codes 59409, 59410, 59612, and 59614). Claims submitted with modifier -22 must include medical record documentation that supports the use of the modifier.

4. Services Excluded from the Global Obstetrical Package

The following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, and 59618)

  • First three antepartum E&M visits
  • Laboratory tests
  • 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 (CPT codes 59000 or 59001)
  • Amniofusion (CPT code 59070)
  • Chorionic villus sampling (CPT code 59015)
  • Fetal contraction stress test (CPT code 59020)
  • Fetal non-stress test (CPT code 59025)
  • External cephalic version (CPT code 59412)
  • Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery
  • E&M services which is unrelated to the pregnancy (e.g. UTI, Asthma) during antepartum or postpartum care.
  • Additional E/M visits for complications or high risk monitoring resulting in greater than the typical 13 antepartum visits.
    • However these E/M services should not be reported until after the patient delivers.
    • Append modifier 25 to identify these visits as separately identifiable from routine antepartum visits.
  • Inpatient E/M services provided more than 24 hrs before delivery
  • Management of surgical problems arising during pregnancy (e.g. Cholecystectomy, appendicitis, ruptured uterus)

5. Non-Global OB Care, or Partial OB Services
Non-global OB care, or partial services, refers to maternity care that is not managed by a single provider or group practice. Billing for non-global OB or Partial care may occur under the following circumstances.

  • A patient transfers into or out of a physician or group practice
  • A patient is referred to another physician during her pregnancy
  • A patient has the delivery performed by another physician or other health care professional not associated with her physician or group practice
  • A patient terminates or miscarries her pregnancy
  • A patient changes insurers during her pregnancy

6. Billing for Non-Global or Partial OB Services
The provider or practice should bill for only the portion of maternity care that is provided. Use the codes below for billing antepartum-only, postpartum-only, delivery-only or delivery and postpartum only services. Only one of the following options should be used, not a combination.

  • Antepartum Care Only
    • For 1 to 3 visits: Use E/M office visit codes.
    • For 4 to 6 visits: Use CPT 59425, This code must not be billed by the same provider in conjunction with one to three office visits, or in conjunction with code 59426.
    • For 7 or more visits: Use CPT 59426– Complete antepartum care is limited to one beneficiary pregnancy per provider.
  • Antepartum Care Only – codes 59425 or 59426 should be billed as described below
    • A single claim submission of CPT code 59425 or 59426 for the antepartum care only, excluding the confirmatory visit that may be reported and separately reimbursed when the antepartum record has not been initiated.
    • The units reported should be one.
    • The dates reported should be the range of time covered,
    • E.g.If the patient had a total of 4-6 antepartum visits, then the physician should report CPT code 59425 with the from and to dates for which the services occurred.
    • CPT 59425 and 59426– These codes must not be billed together by the same provider for the same beneficiary, during the same pregnancy.
    • Pregnancy related E/M office visits must not be billed in conjunction with code 59425 or 59426 by the same provider for the same beneficiary, during the same pregnancy.
  • Delivery Services Only

The delivery only codes should be reported by the same group physician for a single gestation when:

    • The total OB package is not provided to the patient by the same physician or group practice.
    • Only the delivery component of the maternity care is provided, and the postpartum care is performed by another physician or group of physicians.
    • The following CPT codes are for delivery services only:
      •  59409 – Vaginal delivery only (with or without episiotomy and/or forceps)
      •  59514 – Cesarean delivery only
      •  59612 – Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps)
      •  59620 – Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
  • Items Included in the Delivery Services
    Based on CPT and ACOG guidelines, the following items are included in the delivery service codes and should not be reported separately

    •  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, external and internal
      fetal monitoring provided by the attending physician
      Intravenous induction of labor via oxytocin (CPT code 96365-96367)
    • Delivery of the placenta, any method
    • Repair of first or second degree lacerations*
    • Insertion of cervical dilator (CPT 59200) to be included if performed on the same date of delivery.

*As per ACOG (American College of Obstetricians and Gynecologists) coding guidelines, reporting of third and fourth degree lacerations should be identified by appending modifier -22 to the global OB code (codes 59400 and 59610) or delivery only code (codes 59409, 59410, 59612, and 59614). Claims submitted with modifier -22 must include medical record documentation that supports the use of the modifier.

  • Delivery and Postpartum Care Only
    If the physician or group physician provide the delivery and postpartum care only, there are CPT codes that encompass both of these services. The following CPT codes are used for delivery and postpartum care only services

    • 59410– Vaginal delivery only(with or without episiotomy and/or forceps); including postpartum care
    • 59515–Cesarean delivery only; including post partum care
    • 59614–Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care
    • 59622–Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care
  • Items Included in the Delivery and Postpartum Care Only
    • Hospital visits related to the delivery during the delivery confinement  
    • Uncomplicated out patient visits related to the pregnancy
    • Discussionofcontraception
  • Postpartum Care Only
    The postpartum care only should be reported by the same physician that provides the patient with services of postpartum care only. If a physician provides any component of antepartum along with postpartum care, but does not perform the delivery, then the services should be itemized by using the appropriate counterpart care code and postpartum care code. The following CPT codes is used to report postpartum care only:

    • 59430–Postpartum care only (separate procedure)
  • Items Included in the Postpartum Care
    • Uncomplicated out patient visits related to the pregnancy
    • Discussion of contraception
  • Services Excluded from the Postpartum Care
    • E/M encounters for problems or complications related to the pregnancy

References:

• https://www.acog.org/practice-management/coding/coding-library

• AMA CPT Content Module: Global OB codes Reporting and Use