Reimbursement and Billing Flashcards
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Read the first 7 Reimbursement and Billing flashcards as text
Which of the following is NOT included in the global obstetric package?
Answer: Treatment of unrelated medical conditions during pregnancy
The global OB package covers routine antepartum, delivery, and postpartum care, but treatment of conditions unrelated to the pregnancy is billed separately.
Which CPT code represents the global obstetric care package for a planned cesarean delivery, including antepartum and postpartum care?
Answer: 59510
CPT 59510 covers routine obstetric care including antepartum care, cesarean delivery, and postpartum care as a global package.
When an obstetrician performs a significantly more complex procedure due to unexpected intraoperative complications, which modifier is appended to the procedure code?
Answer: -22
Modifier -22 (increased procedural services) is used when the work required is substantially greater than typically required and must be supported by documentation.
When a physician provides antepartum care only (4-6 visits) because another provider will perform the delivery, which CPT code is used?
Answer: 59425
CPT 59425 reports antepartum care only when the provider sees the patient for 4 to 6 visits but does not perform the delivery.
What is the global period assigned to most major gynecologic surgeries, such as an abdominal hysterectomy?
Answer: 90 days
Most major surgical procedures carry a 90-day global period during which routine pre- and postoperative care is bundled into the procedure reimbursement.
Which claim form is used by a physician's office to bill Medicare for OB/GYN professional services?
Answer: CMS-1500
The CMS-1500 is the standard claim form used by physicians and non-institutional providers for billing Medicare and most commercial payers.
Postpartum care only, when the provider did not perform the delivery, is reported with which CPT code?
Answer: 59430
CPT 59430 is used to report postpartum care only when the treating provider did not perform the patient's delivery.