Wiki ANTEPARTEM CARE ONLY OR ANY PORTION OF OB GLOBAL

[baskiles]

If our patient that we've seen throughout their pregnancy ends up having to have a C-section- we bill for the antepartum care and care after delivery when appropriate. We always have to fight insurance for these. Would it make it easier if we added a modifier to the codes, so the carrier knows that we didn't do all of the service related to the OB global? On occasion the provider submitting the C-section charge does bill incorrectly but if they billed correctly- would it make it easier to get our claims paid faster with any type of modifer on our codes? Any direction would be greatly appreciated.

 

[nielynco]

If our patient that we've seen throughout their pregnancy ends up having to have a C-section- we bill for the antepartum care and care after delivery when appropriate. We always have to fight insurance for these. Would it make it easier if we added a modifier to the codes, so the carrier knows that we didn't do all of the service related to the OB global? On occasion the provider submitting the C-section charge does bill incorrectly but if they billed correctly- would it make it easier to get our claims paid faster with any type of modifer on our codes? Any direction would be greatly appreciated.

I am assuming that the physician who performed the cesarean was not affiliated in any way to the provider/s who did the antepartum and postpartum care. You have 2 choices. Bill 59425 or 59426 depending on the total number of antepartum visits and then 59430 for PP care (outpatient). If the physician who performs the cesarean did not provide any follow-up inpatient care, you can bill for that as well. In order for this to work, the delivering MD must bill a DELIVERY ONLY code. The other acceptable was is to use modifier -54, 55, and 56. To have that work each provider bills 59510 and add the appropriate modifiers (cesarean delivery MD uses -54 and you use modifiers -55 and -56. It probably does not speed up claim processing no matter which way you go but you need to have a discussion with the other billing group before submitting the claim to ensure you are all on the same page - that will speed things up.

 

[csperoni]

I don't personally do a lot of claim follow up anymore, but I do sometime come across things afterward, particularly when denials are involved.
In my organization, when there is split billing, we do not use the -54-55-56 mentioned above and each practice bills for the portion they provided. I've never seen claims that way, so can't speak to whether or not it would help or hurt your specific situation.
I have come across some payors that anytime there is a non-global code (even when billed 100% correctly), they want to review all maternity related claims (and sometimes medical records) to be convinced that a global code is not correct. I've seen it with transfers of care and terminations.
I agree with @nielynco it should help if you do reach out to the other practice to ensure everyone is billing appropriately. If everyone is, I don't think there's much you can do to get your claims paid faster if you're doing it right in the first place.

 

[baskiles]

I am assuming that the physician who performed the cesarean was not affiliated in any way to the provider/s who did the antepartum and postpartum care. You have 2 choices. Bill 59425 or 59426 depending on the total number of antepartum visits and then 59430 for PP care (outpatient). If the physician who performs the cesarean did not provide any follow-up inpatient care, you can bill for that as well. In order for this to work, the delivering MD must bill a DELIVERY ONLY code. The other acceptable was is to use modifier -54, 55, and 56. To have that work each provider bills 59510 and add the appropriate modifiers (cesarean delivery MD uses -54 and you use modifiers -55 and -56. It probably does not speed up claim processing no matter which way you go but you need to have a discussion with the other billing group before submitting the claim to ensure you are all on the same page - that will speed things up.

Thank you for taking time to respond. Your reply is helpful!

 

[baskiles]

I don't personally do a lot of claim follow up anymore, but I do sometime come across things afterward, particularly when denials are involved.
In my organization, when there is split billing, we do not use the -54-55-56 mentioned above and each practice bills for the portion they provided. I've never seen claims that way, so can't speak to whether or not it would help or hurt your specific situation.
I have come across some payors that anytime there is a non-global code (even when billed 100% correctly), they want to review all maternity related claims (and sometimes medical records) to be convinced that a global code is not correct. I've seen it with transfers of care and terminations.
I agree with @nielynco it should help if you do reach out to the other practice to ensure everyone is billing appropriately. If everyone is, I don't think there's much you can do to get your claims paid faster if you're doing it right in the first place.

Thank you for taking time to respond, your reply is helpful!