Tuesday, October 31, 2017

Maternity care billing TIPS - Twins, physician changing


Coding CPT guidelines for reporting prenatal care and delivery services apply. Bill the global obstetrical package or the antepartum, delivery, and postpartum components as  appropriate per Medicaid NCCI guidelines.

Delivery Delivery is part of the global maternity package and should not be billed separately if the global package is billed. If the beneficiary is seen for fewer than seven antepartum visits, delivery and postpartum care should be billed separately. Use appropriate CPT guidelines.

Global Service The global maternity package should be billed if the beneficiary is seen for seven or more antepartum visits with delivery and postpartum performed by the same physician or physician group. The provider or group may choose to bill the antepartum, delivery, and postpartum components separately as allowed by Medicaid NCCI editing.

Multiple Gestation For twin gestation, report the service on two lines with no modifier on the first line and modifier 51 on the second line. If all maternity care was provided, report the global maternity package code for the first infant, and report the appropriate delivery-only code for the second infant using modifier 51. If multiple gestation for more than twins is encountered, report the first delivery on one line and combine all subsequent deliveries on the second line with modifiers 51 and 22. Provide information in the remarks section or submit an attachment to the claim explaining the number of babies delivered.

Physician Change During Antepartum Care

If the beneficiary changes physicians during the antepartum care (other than physicians within the same group), use the appropriate maternity CPT codes and guidelines for the services performed. The global package should not be billed by either physician regardless of the number of antepartum visits provided.

Postpartum Care Postpartum care is included in the global maternity package and in the global surgical delivery period when the services are provided by the same physician or physician group. When the postpartum exam is performed by a physician not billing the global package or performing the delivery, the postpartum exam may be billed as a separate service.

Prenatal/Antepartum Care

If the beneficiary receives fewer than seven but greater than three antepartum visits, use the appropriate antepartum CPT code. Individual E/M codes should be used when three or fewer antepartum visits are performed.


When billing for medical services provided to the newborn, providers must use the newborn's Medicaid ID number, except if the delivering physician performs the newborn care and circumcision during the mother's inpatient stay, the delivering physician may bill for the newborn care and circumcision on the same claim as the delivery under the mother's Medicaid ID number.

Global Maternity Care - Medicaid Guideline

Global maternity care includes services normally provided in uncomplicated maternity cases during the period of pregnancy.  Services include antepartum care, labor and delivery, postpartum care, and laboratory services as defined below.  These are not reported as separate services.

Antepartum care  

Antepartum care includes usual prenatal services.  The initial visit must be included as part of antepartum care and is not reported as a separate service.  Antepartum care includes the initial and subsequent history, physical examinations, recording of weight, blood pressure, fetal heart tones, routine chemical analysis, hematocrit, maternity counseling, monthly visits up to 28-week gestation, biweekly visits to 36-week gestation, and weekly visits until delivery.  Also included is the treatment of routine complaints that accompany pregnancy.  Diabetic glucose monitoring is part of the maternity global payment.  Additional billings for an office visit, diabetes self-management training, or nutritional medical counseling for diabetic glucose monitoring in pregnancy is not appropriate.
Labor and delivery services

Labor and delivery services include admission to the hospital, admission history, physical examination, management of uncomplicated labor, vaginal delivery, and cesarean section delivery.

Postpartum care 
Postpartum care includes hospital and office visits following vaginal or cesarean section delivery, a six-week postpartum visit, and obtaining a Pap smear.  Medicaid covers postpartum services up to the end of the month in which the 60 days post-delivery occurs.  Family planning services are covered separately. 

Laboratory Services

Laboratory tests, such as hematocrit and urinalysis, provided during routine visits are included in the global care fee.  Other antepartum and postpartum diagnostic services that have medical indication are reported separately. 

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