Question Antepartum, Delivery, and Postpartum Care Medicaid Billing

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Blue Creek, OH
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Hello,

I work for a large Ob-Gyn practice and we were looking to see how other large practices handle billing Medicaid antepartum, delivery, and postpartum care.

For example:

We have a patient who we provided antepartum care by various providers of the same group, delivery, and postpartum care. We bill antepartum visits with E/M (Eg. 99213), delivery with delivery only code (Eg. 59409) and inpatient postpartum care with subsequent code (Eg. 99231-99238), and 6 week postpartum check-up (Eg. 99213).

We receive payment for all antepartum care and delivery, but receive denials for subsequent inpatient care and the 6 week postpartum check-up. This seems to be based on payers like OH Medicaid and Buckeye.

Do you see scenarios like this? Do you have any insight on billing antepartum care with E/M (Eg. 99213), delivery and postpartum care with delivery and postpartum only code (Eg. 59410)? Or even billing antepartum care with E/M (Eg. 99213), delivery with delivery only code (Eg. 59409), and postpartum care with postpartum only code (Eg. 59430)?
 

Bready

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You have to follow your state's Medicaid rules so I don't know if this info is of any help to you but Texas Medicaid does not allow billing for subsequent inpatient care following a delivery. Hospital care is considered part of the delivery even when using delivery only code and also not considered postpartum care. Postpartum care begins when the patient is discharged from the hospital.(CPT: 59430) So it is antepartum care billed separate per visit; delivery only code, and postpartum only code--59430.
 
Messages
3
Location
Blue Creek, OH
Best answers
0
You have to follow your state's Medicaid rules so I don't know if this info is of any help to you but Texas Medicaid does not allow billing for subsequent inpatient care following a delivery. Hospital care is considered part of the delivery even when using delivery only code and also not considered postpartum care. Postpartum care begins when the patient is discharged from the hospital.(CPT: 59430) So it is antepartum care billed separate per visit; delivery only code, and postpartum only code--59430.
Yes, their policy is postpartum care is included up to 6 weeks of delivery. We've read that CPT 59430 is when antepartum care and delivery is not provided, so only postpartum care was provided. Do you have experience getting this paid? Do you use different providers from the same group?
 

Bready

Guru
Messages
155
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1
Texas Medicaid REQUIRES us to bill ALL services as individual services--antepartum care, delivery, and postpartum care. All must be billed individually. Therefore 59430 applies. We follow their rules and are paid accordingly. We have three providers who will see Medicaid patients. They are all providers on our Medicaid program but altho they have their individual Medicaid numbers that qualifies them to provide services, we also have a group Medicaid ID that we bill our claims under. I don't know if that is what you are asking.
 
Messages
3
Location
Blue Creek, OH
Best answers
0
Texas Medicaid REQUIRES us to bill ALL services as individual services--antepartum care, delivery, and postpartum care. All must be billed individually. Therefore 59430 applies. We follow their rules and are paid accordingly. We have three providers who will see Medicaid patients. They are all providers on our Medicaid program but altho they have their individual Medicaid numbers that qualifies them to provide services, we also have a group Medicaid ID that we bill our claims under. I don't know if that is what you are asking.
Yes, that was my question. If you've received payment on 59430 when antepartum care and delivery have also been billed by a provider within the same group. Thanks for your input.
 
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