Changes in OB GYN Billing Global Periods: What You Need to Know
Only one specific area has been modified. In 2025, new telehealth CPT codes were introduced; however, the adoption by Medicare remains limited. Being aware of these updates safeguards your revenue and ensures compliance, as improper obstetric global billing consistently ranks among the leading causes of claim denials. What is a Global Period in OB GYN? Global-period billing includes prenatal, delivery, and postpartum services consolidated into a single bundled reimbursement for obstetrical care. Instead of billing individually for each prenatal appointment, delivery, and postpartum care, you submit one all-encompassing code that addresses the complete pregnancy experience from the initial prenatal visit to the concluding postpartum examination. The global package typically includes postpartum care for six weeks following delivery, after which additional visits necessitate separate billing. This is distinct from surgical global periods that utilize specific day counts, such as 10-day or 90-day periods. OB-GYN global billing encompasses the entire range of routine pregnancy care, irrespective of duration. Core Codes You Need to Know Global Package Codes Utilize when your practice provides comprehensive pregnancy care: 59510: Cesarean delivery with complete care. 59610: Vaginal birth after previous cesarean with complete care. 59618: Cesarean after attempted VBAC with complete care. Component Codes Utilize when you only manage part of the pregnancy care: 59409/59514: Delivery only (vaginal/cesarean). 59425: Antepartum care, 4-6 visits. 59426: Antepartum care, 7+ visits. 59430: Postpartum care only. Decision Rule: Did you only manage certain aspects while other providers took care of different parts? Utilize component codes. New Telehealth CPT Codes with Limited Medicare Recognition New CPT codes have been introduced for the year 2025, which include 98000-98007 (audio-video), 98008-98015 (audio-only), and 98016 (brief communication). These codes inherently represent telehealth services and do not necessitate modifier 95. However, Medicare currently acknowledges only 98016; 98000-98015 are not reimbursable by Medicare (although some commercial plans may cover them). Virtual consultations that are included in standard prenatal or postpartum care continue to be part of the global package. They cannot be billed separately merely because they are performed through telehealth. However, telehealth consultations for complications or issues that fall outside the standard global package may be billed separately using the relevant evaluation and management codes or code 98016 when applicable. What Did NOT Change? CPT codes remain unchanged from 2024. Global package regulations have not altered. Bundling principles remain consistent. The regulations regarding split and shared visits will persist from 2024, upholding the same substantive portion requirements and the use of modifier FS (applicable only to facility settings). Services that were eligible for separate billing in 2024 will remain eligible for separate billing in 2025. Telehealth Rules for 2025 Bundled services will remain bundled irrespective of the delivery method. Routine prenatal telehealth appointments, virtual postpartum check-ups, and standard pregnancy education sessions held online are encompassed within your global package payment. What Can You Bill Separately? Telehealth visits addressing complications. Virtual care for unrelated medical issues. Coding Requirements Utilize service code 02 for alternative telehealth locations or 10 for a patient’s residence. For traditional E/M codes, most commercial insurers require modifier 95, although Medicare requirements differ by MAC. The recently introduced telehealth CPT codes (98000-98015) do not necessitate the use of modifier 95, as telehealth is inherently encompassed within the code description; nevertheless, it is crucial to highlight that Medicare does not recognize these codes. Important Note Medicare’s expanded telehealth flexibilities (including home as the originating site) are effective until September 30, 2025. Code 98016 supersedes HCPCS G2012 for brief communications. Making the Right Choice: Global vs Component Codes Use Global Codes When Your practice manages the entire pregnancy. Use Component Codes When The patient transitions between practices. You only perform delivery without providing prenatal care. Another practice manages postpartum care. Real Examples A patient moves to a different location during pregnancy: The initial practice charges for the antepartum code, whereas the new practice charges for the global code. Hospital delivery involving a different obstetric group: The prenatal practice charges for the antepartum code, while the hospital group charges for the delivery-only code. You handle the call and provide an unknown patient: Charge the delivery-only code. Essential Modifiers for 2025 Essential Modifiers You Should Use Modifier 25: Significant, separately identifiable E/M service on the same day as another procedure (note that this modifier is often misapplied in OB claims, so ensure proper documentation). Modifier 95: Telehealth services when utilizing traditional E/M codes (not required for new telehealth-specific CPT codes). Modifiers That Don’t Belong on OB Claims Modifier 90: Laboratory services for reference (not applicable during global periods). Modifier 91: Laboratory tests repeated (not applicable during global periods). These laboratory modifiers are irrelevant to obstetric global billing and can cause confusion in claims. Understanding Various Payer Requirements Medicare’s Strategy for OB Global Billing Medicare employs the “MMM” indicator for obstetric global packages, setting them apart from surgical global periods. Telehealth coverage remains available until September 30, 2025, allowing patients to access services from home without geographic limitations. Commercial Insurance Differences Many insurers align with Medicare’s guidelines but may exhibit particular variations: The precise number of postpartum visits included. Distinct telehealth stipulations. State-specific regulations (such as North Carolina’s new F-codes effective after July 1, 2025). It is essential to confirm the policies of individual payers instead of presuming consistent coverage. How to Accurately Bill for OB/GYN in 2025? Standard Pregnancy Care The patient receives comprehensive prenatal care, undergoes delivery, and completes postpartum care within your practice. Code: Employ the correct global code (59400, 59510, etc.) Mid-Pregnancy Transfer If a patient transfers to your practice at 28 weeks, you will provide continuous care and delivery. Code: Apply the global code as you have delivered significant antepartum care along with the delivery. Telehealth for Postpartum Complications Should a patient experience postpartum depression necessitating a virtual consultation beyond standard care? Code: Utilize the appropriate E/M code
How Does a General Surgery EHR Differ from a Generic EHR System?
Currently, approximately 96% of hospitals in the United States utilize an Electronic Health Record (EHR) system; however, nearly half of surgical specialists continue to rely on generic systems. This leads to slower documentation processes, an increase in the number of clicks required, and the omission of crucial details essential for surgical care. Research indicates that transitioning from a generic EHR to a platform specifically designed for surgery can enhance documentation efficiency from 6.02 to 7.20 on a scale of 10. This transition results in more precise records, improved claim tracking, and enhanced workflow support. But what precisely distinguishes a general surgery EHR from a generic one? Why is this distinction significant for surgeons, patients, and hospitals? Let us begin with the fundamentals. What Distinguishes General Surgery EHR from Generic EHRs? Not all EHR systems are created equal. A general surgery EHR is specifically tailored for the workflows associated with surgical billing systems, whereas a generic EHR offers only broad, standard functionalities. A general surgery EHR encompasses templates for pre-operative and post-operative procedures, along with tools for creating operative notes. It also features surgical scheduling capabilities and coding tools specific to surgery. In contrast, a generic EHR provides basic functionalities such as charting, scheduling, and lab orders. However, surgeons frequently require customization, which can hinder efficiency and increase the likelihood of billing errors. Comparison of General Surgery EHR and Generic EHR General Surgery HER Generic EHR Templates for Pre-op, intra-op, and post-op Basic charting templates OR block scheduling and surgical calendars Standard patient scheduling CPT, ICD-10, and modifiers tailored for surgery General coding support Auto-populated operative notes Manual or limited note fields Tracks global periods and compliance Limited compliance features Reduces denials, maximizes revenue. Higher risk of errors and lost revenue What is a General Surgery EHR? A general surgery electronic health record (EHR) denotes a digital record system tailored specifically for surgical practices. It aligns with the workflow of surgeons, resulting in more precise documentation, easier compliance, and the ability for practices to secure full reimbursement. What is a Generic EHR? A Generic EHR is a flexible electronic health record system designed to serve multiple specialties. It provides fundamental EHR functionalities. While a generic EHR is effective for routine care, it typically lacks surgical templates and billing tools. Workflow in General Surgery EHR vs. Generic EHR General Surgery EHR Workflow An EHR tailored for the surgery streamlines the entire process. Pre-operative procedures begin with integrated templates. Operating room time is scheduled directly within the system, eliminating unnecessary back-and-forth communication. Subsequently, it applies the appropriate CPT codes and modifiers according to U.S. regulations to mitigate billing errors. Follow-up appointments are linked to the same episode of care, ensuring that nothing is overlooked. Generic EHR Workflow In contrast, a generic EHR requires more effort for every task. Pre-operative and post-operative notes must be created from scratch or extensively modified. Operating room scheduling occurs outside the system, leading to delays and miscommunication. Operative notes are entered manually, increasing the likelihood of omitting important details. Billing necessitates a review of codes and modifiers due to the absence of surgery-specific prompts. Additionally, follow-up appointments are monitored as standard office visits, resulting in compliance issues and slower reimbursement. Step in Workflow General Surgery EHR Generic EHR Pre-Op Prep Integrated surgical templates Custom notes created manually. OR Scheduling Direct operating room block scheduling Managed externally or with additional tools Operative Notes Auto-filled procedure fields Manual, labor-intensive entry Billing & Coding Surgery-specific CPT, modifiers, and global period tracking General coding: high risk of errors Post-Op & Follow-Up Bundled care is automatically tracked Handled as regular visits; risk of missed compliance. Differences Between General Surgery EHR Billing and Generic EHR General Surgery EHR Billing Specialty coding: Incorporates built-in CPT and ICD-10 codes specifically for surgical procedures. Modifier support: Automatically applies the appropriate surgical modifiers. Global period tracking: Monitors bundled pre-, intra-, and post-operative periods to prevent double-billing. Op note integration: Extracts billing codes directly from the operative note. Fewer denials: Surgery-specific validations minimize coding errors and denials. General surgery billing software leads to expedited claim submissions, cleaner claims, reduced denials, and enhanced reimbursement accuracy. Generic EHR Billing Basic Coding Support: Manages general CPT/ICD-10 codes but lacks the specificity required for surgical procedures. Limited Modifier Use: Modifiers often need to be manually added by coders or billers. No Global Period Tracking: Considers follow-up visits as separate appointments, which may lead to compliance issues and denials. Manual Data Entry: Operative details do not automatically link to billing; coders are required to manually extract the information. Higher Denial Rates: Increased errors and missed charges arise from the absence of specialty-specific checks. In comparison to general surgery medical billing software, generic billing necessitates more manual effort, results in higher denial rates, prolongs the revenue cycle, and increases the risk of underpayment for surgical practices. What are the Advantages and Disadvantages of General Surgery EHR and Generic EHR? General Surgery EHR Advantages Disadvantages Templates tailored to the specialty Higher expenses in comparison to general EHRs Management of OR block scheduling and surgical workflows May necessitate additional training for staff to utilize advanced functionalities Integrated surgical coding support (CPT, ICD-10, modifiers, global periods) Demands extensive staff training Enhances billing precision and decreases claim denials Excessive dependence on EHRs Boosts compliance with specialty-specific regulations The implementation process is prolonged. Generic EHR Advantages Disadvantages Lower initial costs compared to specialty EHRs Lacks templates and workflows specific