The global maternity fee encompasses maternity-related services performed by all providers in uncomplicated maternity cases. Global services are also known as total maternity care or global maternity services/care.

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For services rendered during the maternity period, civicpride-kusatsu.net pays a global fee for prenatal care, false labor, and delivery, The global fee also includes the treatment of routine gynecological conditions during scheduled prenatal visits. Treatment for these conditions during scheduled prenatal visits should not be billed to civicpride-kusatsu.net as a separate evaluation and management (E/M) visit.

civicpride-kusatsu.net pays for the initial prenatal visit and the routine follow up visit after delivery outside the global fee. The initial prenatal visit is defined as the visit during which the physician or nurse midwife initiates prenatal care, counsels the patient about risk factors and self-care, determines the patient"s due date and establishes a tentative schedule of future visits. The routine follow up visit after delivery as recommended by Healthcare Effectiveness Data and Information Set (HEDIS) occurs 7 to 84 days after delivery. Refer to Prenatal Visit – Initial and Follow Up after Delivery.

Severe medical complications of high complexity, such as toxemia, uremia, etc., will be recognized and considered for payment in addition to the global allowance.

Urinalysis (CPT codes 81000 and 81002) are considered an integral part of a prenatal visit and are not paid separately.

Claims Filing Information

You may submit claims for maternity services under a global fee (i.e., 59400 for vaginal delivery or 59510 for cesarean delivery). If you or another provider submits separate claims for prenatal care, delivery, and postnatal services, civicpride-kusatsu.net will pay the individual claims separately up to the amount that would have been paid for the global fee. Do not submit claims using both the global code and individual codes.

If you are billing globally, please do not submit claims for E/M visits in cases where a routine pregnancy-related condition (e.g., hyperemesis) was treated during a prenatal visit. If you treat a patient for a serious complication of pregnancy or for a condition that is unrelated to the pregnancy, you may submit a claim for the services you perform.

If you submit a claim for a complication, be sure the claim is submitted with the appropriate diagnosis. The claim will be processed for benefits separate from the global maternity fee.

Example 1

Physician performs routine obstetric service.

Diagnosis:

Pregnancy - single, routine, without sickness (ICD-9-CM: V22.2/ICD-10-CM: Z33.1)

Claim contains:

59400

Routine obstetric care (including prenatal care, vaginal delivery and postpartum care)

81000

Urinalysis

civicpride-kusatsu.net will:

Pay a global maternity fee. Additional payment for the urinalysis would be denied. Urinalysis is considered an integral part of a prenatal visit and is included in the global fee.

Example 2

Patient complains of vaginal discharge during a scheduled prenatal visit to her obstetrician.

Diagnoses:

Vaginitis (ICD-9-CM: 616.10/ICD-10-CM: N76.0)

Pregnancy - single, routine, without sickness (ICD-9-CM: V22.2/ICD-10-CM: Z33.1)

Claim contains:

99212

Office visit

civicpride-kusatsu.net will:

Pay for the visit, but deduct the amount paid from the physician"s global fee. Treatment of routine gynecological conditions is included in the fee for global maternity services and should not be billed separately.

Example 3

Patient is diagnosed with toxemia during a scheduled prenatal visit to her obstetrician.

Diagnosis:

Toxemia (ICD-9-CM: 642.63/ICD-10-CM: O15.02)

Claim contains:

99212

Office visit

civicpride-kusatsu.net will:

Pay the visit separately from the global fee.

Billing for Multiple Gestation Deliveries

When billing the global maternity fee for multiple gestation deliveries, the provider should use the appropriate CPT code (i.e., 59400 or 59610 for vaginal delivery or 59510 or 59618 for cesarean delivery) and add a modifier 22. The diagnosis indicated in block 21 of the CMS 1500 claim form should reflect the multiple birth (e.g., ICD-9-CM: 651.01/ICD-10-CM: O30.013 to represent twins) and a comment should appear in block 19 (e.g., twins or triplets).

Billing for Tubal Ligation with Cesarean Section

civicpride-kusatsu.net plans allow additional payment when tubal ligation is performed in conjunction with a cesarean section. The tubal ligation should be coded using CPT code 58611.

See more: How Did The Renaissance Encourage Exploration? ? Age Of Exploration #2

BIM / PO: December 2018


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