Saturday, October 15, 2011

Global days for Maternity codes?

This week I was asked a question in regard to global days and maternity codes...  I always feel that if one person has this question, there may be others out there that are thinking the same way....    Enjoy... 

Q:  My physician is adamant that the global time for maternity care is 90 days...  but I was always under the impression it was only for 6 weeks?  Who is right??? 

A:  Technically - you both are correct.   CMS and CPT  global codes are designated as -0-. 10, or 90 day global care timeframes, however with maternity codes the 2011 National Physician Fee Schedule database designates those codes as MMM which means they are not subject to the -0-, 10, 90 day rules.  The MMM designation simply means that this is a maternity code, and the usual global concept does not apply.  However, the global concept of Antepartum, Delivery and postpartum care are all inclusive - to be billed as a package. 

Practice Standard for maternity care is broken down below: 
Antepartum care = aprox 13 office or outpatient care visits, up to admission to the hospital for delivery

Intrapartum/Delivery Care:  Care of the patient during the labor process, delivery of the infant, and post delivery care prior to hospital discharge (uncomplicated such as vaginal, cesarean section, v-back)

Postpartum Care:  Care of the uncomplicated delivery patient in the office/outpatient setting  from the time of hospital discharge up to 90 days post delivery. 

So, to sum up the answer - most vaginal delivery patients will only need care up to 6 weeks (45 days) however some patients may need post-partum care up to 12 weeks (90 days) for cesarean section.  So technically both of you are correct.  

The only way to definitively answer, is to check with your contracted insurance carriers and ask regarding timeframes for maternity care benefits.  Most of the Medicare/Medicaid carriers will adjudicate the maternity care to the 90 day limit, even though the Database states MMM. 

as always...... Feel free to e-mail me if you have questions...  HAPPY CODING!!! 






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