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1.EGD CPT Code Explanation (43235-43259)

2.Colonoscopy CPT Code Explanation (45300-45399)
3.Hernia Repair
Cholecystectomy


Source :https://neolytix.com/maternity-obstetrical-care-medical-billing/

Currently, global obstetrical care is defined by the AMA CPT as “the total obstetric package includes the provision of antepartum care, delivery, and postpartum care.” (Source: AMA CPT codebook 2022, page 440.)

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

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.
 

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.

     

  • Antepartum Care

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

  • All routine prenatal visits until delivery ( ≈ 13 encounters with patient)

  • 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


     

  • Intrapartum Care AKA Labor & Delivery

  • Labor and delivery include:

  • 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

  • Vaginal, cesarean section delivery, delivery of placenta only (the operative report)

  • NOTE: For any medical complications of pregnancy, see the above section “Services Bundled into Global Obstetrical Package.”

  • Postpartum Care

  • Postpartum care includes the following:

  • 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

    The American College of Obstetricians and Gynecologists (ACOG) has developed a list of procedures that are excluded from the global package.

     

  • Surgical Procedures during pregnancy . Examples include urinary system, nervous system, cardiovascular, etc.

  • Laceration repair of a third- or fourth-degree laceration at the time of delivery.  Per ACOG coding guidelines, this should be reported using modifier 22 of the CPT code used to bill.

  • Contraceptive management services (insertions)

  • Cerclage, or the insertion of a cervical dilator more than 24 hours from admission.

  • External cephalic version (turning of the baby due to malposition).

     

  • 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.

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  • 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.

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