The global maternity fee incorporates maternity-related solutions performed by all providers in uncomplicated maternity cases. An international services are likewise known as full maternity care or global maternity services/care.

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For solutions rendered throughout the maternity period, gaianation.net payment a worldwide fee for prenatal care, false labor, and delivery, The global fee likewise includes the treatment of routine gynecological problems during booked prenatal visits. Therapy for these problems during scheduled prenatal visits should not it is in billed to gaianation.net as a separate evaluation and also management (E/M) visit.

gaianation.net pays for the initial prenatal visit and the regimen follow increase visit after shipment outside the global fee. The initial prenatal visit is characterized as the visit during which the doctor or nurse midwife initiates prenatal care, counsels the patient around risk factors and also self-care, determines the patient"s due date and also establishes a tentative schedule that future visits. The routine follow increase visit after distribution as encourage by Healthcare efficiency Data and also Information set (HEDIS) wake up 7 come 84 days after delivery. Refer to Prenatal Visit – Initial and Follow increase after Delivery.

Severe clinical complications of high complexity, such as toxemia, uremia, etc., will certainly be recognized and considered because that payment in enhancement to the global allowance.

Urinalysis (CPT codes 81000 and also 81002) are considered an integral component of a prenatal visit and are no paid separately.

Claims submit Information

You may submit claims for maternity services under a an international fee (i.e., 59400 for vaginal shipment or 59510 for cesarean delivery). If girlfriend or an additional provider submits separate insurance claims for prenatal care, delivery, and postnatal services, gaianation.net will pay the individual claims separately as much as the amount the would have actually been paid because that the global fee. Carry out not submit claims using both the worldwide code and also individual codes.

If you room billing globally, please do not submit insurance claims for E/M access time in cases where a program pregnancy-related problem (e.g., hyperemesis) to be treated throughout a prenatal visit. If you treat a patient for a significant complication of pregnancy or for a condition that is unrelated come the pregnancy, you may submit a claim for the solutions you perform.

If you send a case for a complication, be sure the claim is submitted through the ideal diagnosis. The insurance claim will it is in processed because that benefits different from the global maternity fee.

Example 1

Physician performs routine obstetric service.

Diagnosis:

Pregnancy - single, routine, there is no sickness (ICD-9-CM: V22.2/ICD-10-CM: Z33.1)

Claim contains:

59400

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

81000

Urinalysis

gaianation.net will:

Pay a global maternity fee. Added payment because that the urinalysis would be denied. Urinalysis is considered an integral part of a prenatal visit and is had in the global fee.

Example 2

Patient complains of quality discharge during a reserved prenatal visit to she obstetrician.

Diagnoses:

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

Pregnancy - single, routine, there is no sickness (ICD-9-CM: V22.2/ICD-10-CM: Z33.1)

Claim contains:

99212

Office visit

gaianation.net will:

Pay because that the visit, but deduct the amount payment from the physician"s worldwide fee. Treatment of routine gynecological problems is consisted of in the fee for worldwide maternity services and also should not be billed separately.

Example 3

Patient is diagnosed through 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

gaianation.net will:

Pay the visit individually from the an international fee.

Billing because that Multiple Gestation Deliveries

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

Billing for Tubal Ligation through Cesarean Section

gaianation.net plan allow added payment as soon as tubal ligation is performed in conjunction v a cesarean section. The tubal ligation need to be coded using CPT code 58611.

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BIM / PO: December 2018


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