Ob-Gyn Coding Alert

Question: One of my ob-gyn's patients changed her insurance during her pregnancy. I was told to split antepartum care and bill appropriate number of visits to each insurance, but what if this patient had four visits with Anthem and 10 antepartum visits, delivery, and postpartum with Aetna? Should I just bill global to Aetna?

Texas Subscriber

Answer: Most payers will let you know if they expect you to bill globally, even if she had a previous insurance during her pregnancy. But they don't want to pay more than they were responsible for. So you could bill 59425 (Antepartum care only; 4-6 visits) to Anthem and then 59400-52 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care; Reduced services) to Aetna, and let them know the circumstance. Aetna would then decide whether to pay you their full allowable or reduce it.