PRV1_0119_ProviderManual-Commercial.pdf

Preoperative period that are usually not part of the

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preoperative period that are usually not part of the basic surgical procedure (for example, bronchoscopy prior to chest surgery); and Treatment by the original physician for a related post-operative complication that requires a return trip to the operating room. 11.3 Obstetric and Gynecology Care Billing Guidelines 11.3.1 Global OB Care 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, the provider must bill the Global OB code, beginning with the date of the initial prenatal visit. Global maternity billing ends with release of care within 42 days after delivery. Global OB care should be billed after the delivery date. Services Included in Global Maternity Care 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 (see “Billable Services Outside of Global Maternity Care” for examples of when delivery of the placenta may be reimbursed). • Administration/induction of intravenous oxytocin Insertion of cervical dilator on same date as delivery • 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
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Section 11 | Billing Requirements 63 Please use one of the CPT codes listed below when you provide global OB care. Global care includes all obstetrical care for a patient, including delivery, antepartum, and postpartum care. Global OB care should be billed after the delivery date. 59400 Routine obstetrical 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 11.3.2 Partial Services Nonglobal OB care, or partial services, refers to maternity care not managed by a single provider or group practice. Billing for nonglobal OB care may occur if a member transfers care or is referred to another provider during her pregnancy, a provider from another
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  • Winter '16
  • Dr. Vincent Onyebuchi
  • PacificSource

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