There will be times when an OB/GYN provider will provide all of the antepartum care to a patient (prenatal visits), including the post-partum care (after delivery) but not perform the delivery. As a Medical Coder, this is essential to know if we will be billing visits and care separately or together as a global package; this is a huge difference in reimbursement!
Apply your understanding of coding and theory to this patient example.
Include the following aspects in the discussion:
Identify an example of when an OB patient may not have the same provider for the antepartum, delivery, and postpartum services.
Explain what code or codes would be used for this scenario. Assume that the patient has had seven antepartum visits.
Discuss at least two services that are part of antepartum care.
Sample Answer
As a medical coder, understanding the nuances of OB/GYN billing, particularly when different providers render portions of the maternity care, is indeed critical for accurate reimbursement. The "global package" concept for maternity care simplifies billing but has strict rules for when it applies.
Example of an OB Patient Not Having the Same Provider for Antepartum, Delivery, and Postpartum Services
A common scenario where an OB patient might not have the same provider for all three phases of maternity care (antepartum, delivery, and postpartum) is when a patient is transferred late in pregnancy or during labor to a higher-level facility or a different provider due to complications or a change in circumstances.
Example: Imagine a patient, Maria, has been receiving all her prenatal (antepartum) care from Dr. Anya, an OB/GYN in a rural clinic. She's had 7 uneventful prenatal visits. However, at 38 weeks gestation, during a routine prenatal check-up, Dr. Anya identifies that Maria has developed severe pre-eclampsia. Given the risks involved, Dr. Anya immediately transfers Maria to a tertiary hospital in a larger city that has a specialized high-risk obstetrics unit and a neonatal intensive care unit (NICU). At this new hospital, Maria is admitted and her delivery is managed by Dr. Ben, a different OB/GYN on call, who also provides her immediate postpartum care before she is discharged home. Dr. Anya (the initial provider) will then provide the 6-week postpartum follow-up visit.
In this scenario:
Antepartum care (7 visits): Provided by Dr. Anya.
Delivery: Provided by Dr. Ben.
Postpartum care (initial hospitalization): Provided by Dr. Ben.
Postpartum care (follow-up visit): Provided by Dr. Anya.
This situation clearly breaks the global package, as multiple providers are involved.