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.
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,”