COBGC Reimbursement and Billing 3 — Questions and Answers
Question 1: Which modifier indicates that a significant, separately identifiable E/M service was provided on the same day as a minor procedure by the same physician?
- -24
- -25 (Correct answer)
- -51
- -59
Correct answer: -25
Modifier -25 is appended to the E/M code to show it was a significant, separately identifiable service from the procedure performed on the same day.
Question 2: For a pregnant patient covered by both her own employer plan and her spouse's plan, which plan is primary for her maternity services?
- The spouse's plan because it covers dependents
- The patient's own insurance plan (Correct answer)
- The plan with the higher lifetime maximum benefit
- Medicare, if the patient qualifies by age
Correct answer: The patient's own insurance plan
Under coordination of benefits (COB) rules, a patient's own insurance is always primary for services she personally receives.
Question 3: A patient at 34 weeks gestation is hospitalized for management of severe preeclampsia. How are these inpatient services billed?
- As part of the global antepartum care package
- Separately from the global OB package as a complication (Correct answer)
- Only after delivery as part of the postpartum period
- Using antepartum-only codes 59425 or 59426
Correct answer: Separately from the global OB package as a complication
Complications of pregnancy requiring inpatient hospital care are billed separately from the global OB package using appropriate hospital visit codes.
Question 4: Which HCPCS Level II code category is used to report injectable drugs administered in the OB/GYN office, such as Rho(D) immune globulin?
- E codes (durable medical equipment)
- G codes (temporary procedures and services)
- J codes (drugs administered other than oral method) (Correct answer)
- Q codes (temporary codes for specific services)
Correct answer: J codes (drugs administered other than oral method)
HCPCS Level II J codes represent drugs administered other than by the oral method, including injections given in a physician's office.
Question 5: Which of the following services is typically BUNDLED within the global obstetric delivery package and cannot be billed separately?
- Treatment of a urinary tract infection diagnosed during pregnancy
- Amniocentesis performed for genetic testing at 16 weeks
- Management of newly diagnosed gestational diabetes
- Routine episiotomy performed during vaginal delivery (Correct answer)
Correct answer: Routine episiotomy performed during vaginal delivery
Routine episiotomy repair is considered an integral part of vaginal delivery and is included in the global obstetric delivery package.
Question 6: A physician provides 7 or more antepartum visits but another provider performs the delivery. Which CPT code does the first physician report?
- 59400
- 59425
- 59426 (Correct answer)
- 59430
Correct answer: 59426
CPT 59426 reports antepartum care only when the provider sees the patient for 7 or more visits but does not perform the delivery or postpartum care.
Question 7: Under Medicare's physician fee schedule, OB/GYN services are reimbursed using which payment methodology?
- Diagnosis Related Groups (DRGs)
- Resource-Based Relative Value Scale (RBRVS) (Correct answer)
- Ambulatory Payment Classifications (APCs)
- Per diem inpatient payment rates
Correct answer: Resource-Based Relative Value Scale (RBRVS)
Medicare pays physicians using the RBRVS system, which assigns relative value units (RVUs) covering physician work, practice expense, and malpractice to each service.
COBGC Reimbursement and Billing 3
Which modifier indicates that a significant, separately identifiable E/M service was provided on the same day as a minor procedure by the same physician?