Global maternity involves the billing process for maternity-related claims for a beneficiary. Once a beneficiary has been diagnosed as pregnant, all charges related to the pregnancy are grouped under one global maternity diagnosis code for the rendering professional provider.
These diagnosis codes will be listed as the primary diagnosis when billing. Figure 8.2 lists examples of these codes.
Figure 8.2 Global Maternity Diagnosis Codes Examples
|
Code
|
Description
|
|
V22
|
Normal pregnancy |
|
V22.0
|
Supervision of normal first pregnancy |
|
V22.1
|
Supervision of other normal pregnancy |
|
V22.2
|
Pregnant state, incidental |
When beneficiaries are referred for specialty obstetric care, prior authorization must be obtained for both outpatient and inpatient services.
Professional and technical components of medically necessary fetal ultrasounds are covered outside the maternity global fee. The medically necessary indications include (but are not limited to) clinical circumstances that require obstetric ultrasounds to: estimate gestational age, evaluate fetal growth, conduct a biophysical evaluation for fetal well-being, evaluate a suspected ectopic pregnancy, define the cause of vaginal bleeding, diagnose or evaluate multiple gestations, confirm cardiac activity, evaluate maternal pelvic masses or uterine abnormalities, evaluate suspected hydatidiform mole, and evaluate the fetus’ condition in late registrants for prenatal care.
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