Medical Billing Dilemma – Billing Global

Babies are going to come when they are good and ready and when a baby is being born there is nothing that can be done to stop it in the event of a normal vaginal birth, a doctor may not be on hand to deliver the baby. A situation that isn’t uncommon is for a nurse to deliver a baby when the ob-gyn is in the next room doing a procedure on another patient such as an episiotomy; then the question arises, can the service still be billed globally?

Fortunately in many cases you can. It is up to the individual payer and you can find out quickly by either checking their guidelines or website to see if the service will be a covered module in the overall procedure. In the event that is, you can use a global code such as 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). To cover the delivery and then back it up by adding modifier 52 (Reduced services) to explain that the ob-gyn was not present at the time of the delivery.

Make sure that the medical documentation notes all the procedures leading up to the delivery that the physician did participate in as well as the services rendered by the nurse to show exactly which medical professional performed which services. This will help lessen the chance of a reduced payment or partial reimbursement on the medical billing claim.

View all Articles by: Melissa Clark, CCS-P