Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > OB/GYN
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 08-27-2012, 01:13 PM
ekarsky@aqreva.com ekarsky@aqreva.com is offline
Contributor
 
Join Date: Apr 2007
Posts: 23
ekarsky@aqreva.com is on a distinguished road
Default OB Billing Guidelines

I have two situations where the insurance is requesting we split out all antepartum charges by date and also bill the delivery seperate. On patient was not effective on her plan until OB had already begun and her insurance has requested we split out all antepartum codes by date. The second patient has insurance through a temp agency and her coverage could terminate on a week to week basis depending on if their is work that particular week so they have also requested all antepartum be billed out by date. I feel as though we are billing these OB services the way the insurance wants them and not based on correct coding guidelines. Is there any information or instruction stating that this type of "split" billing is allowed when the insurance carrier requests it ?
Reply With Quote
  #2  
Old 08-28-2012, 07:33 AM
Leandra Leandra is offline
Guru
 
Join Date: Apr 2007
Location: Grand Rapids
Posts: 142
Leandra is on a distinguished road
Default

We have several payers that require the maternity billing be split out by prenatal visits, delivery and postpartum visit - if we don't split it out like their policy states then we don't get paid. Unless you have a specific arrangement in writing with a payer on how to submit these claims I would bill them the way their policy states.

Many of our OB patients switch/change/lose insurance during the course of their pregnancy. I go back through when they deliver to decipher what they had when and bill each payer accordingly by splitting out the charges. It is the most accurate and legitimate way to bill.
__________________
Leandra Tufts, CPC, COBGC
Reply With Quote
  #3  
Old 08-28-2012, 08:16 AM
holmes.tammy@sbcglobal.net holmes.tammy@sbcglobal.net is offline
New
 
Join Date: Apr 2007
Posts: 7
holmes.tammy@sbcglobal.net is on a distinguished road
Default

If you enter normal visits-59420, in your system as a zero $ when patient is seen then it is easy to know how many visits by looking at your history on patient account. If they deny the claim when billing according to guidelines "59400 or59510 then simply use their appeal form online "or your own if you have one" and print a summary from your patient account that lists all services from first New OB visit to the last. If a payer requires this all the time then simply attach one to each claim when the original one goes out. I have never seen a fee schedule that has an allowed amount for a normal visit-59420. For extra help contact ACOG if you are a member, alot of the times they will have pre-printed letters that explain the billing procedures and guidelines that you can attach to any appeal. For example an assistant at cesarean delivery being denied, I received a letter and have been appealing when denied by some of the smaller self-funded groups, 90% of the time I have been successful.
__________________
Tammy B.
OB/GYN
Reply With Quote
  #4  
Old 08-28-2012, 11:22 AM
ekarsky@aqreva.com ekarsky@aqreva.com is offline
Contributor
 
Join Date: Apr 2007
Posts: 23
ekarsky@aqreva.com is on a distinguished road
Smile OB Billing

Thank you ladies for you help.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 08:56 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC