This page addresses follow-up questions and additional information pertinent to our webinar
Part of the Package? Reporting E/M During Global OB Package.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: If a pregnancy is considered high-risk is it still treated as a routine or uncomplicated maternity global package?
A: For high-risk pregnancies, the global package remains the same. However, if complications arise during the high-risk pregnancy and the patient requires more than the typical 13 antepartum visits, evaluation and management codes may be reportable for the extra visits, depending on payor policy. You will want to link diagnosis codes reflecting the high-risk status or complications to support medical necessity.

Q: A private OB group provides prenatal care and delivery service and the outpatient postpartum checks. But, while the patient is in the hospital post delivery, the hospitals OB/GYN group (a different tax ID) does the postpartum checks prior to discharge. Is the hospital OB/GYN group able to report a separate E/M service for the postpartum care?
A: Routine post partum checks are part of the global delivery code (59400, 59510, etc), so there are various things to consider in regards to two different groups performing routine services. If the private OB group is also providing inpatient post partum checks, that is part of the package for the private group and the hospital providers may not report the service.
Is there an advance agreement in place for hospital OB group to provide routine inpatient post partum services, including renumeration? If so, the hospital OB group should not bill an EM separately. If there is no arrangement between the two groups and the private OB group is unable to perform the inpatient post partum services, the hospital group may report subsequent care codes. However, the private group may need to use a modifier 52 for reduced services on their global code due to not performing all services included in the global package.
CPT Assistant 2022 February – Questions and Answers

Q: Conditions not related to the pregnancy may qualify for a separate evaluation and management service, how do we determine if the condition is not related to the pregnancy
A: This will be up to the documentation. It is the provider’s responsibility to state the condition being treated is not affecting the pregnancy or related to the pregnancy. The diagnosis code used along with the evaluation and management code will also be key in these situations. If the documentation indicates the condition is unrelated to the pregnancy, use a diagnosis code unrelated to pregnancy followed by the pregnant incidental z-code. Z33.1.
We recommend a query to the provider for clarification if the documentation is not clear as to the relationship between the condition and the care or procedure.

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