Question BILLING ANTEPARTUM(59425/59426)_OB Transfer Pts

[centralizedcoding]

HOW ARE YOU BILLING & GETTING PAID FOR A/P CARE ON OB PTS THAT TRANSFER INTO YOUR PRACTICES??

For Example: Pt transfers from another OB provider into our practice at 24wks & we provide remainder of routine antepartum care visits (7), delivery and postpartum care. I would bill 59426 for the 7 A/P visits & Delivery including PP with: 59410 /or/ 59515. Insurance always pays for the delivery on these but every single time they will deny the A/P 59425 /or/ 59426 as bundled or max limit things along those lines which I assume is because the pts prior OB office already billed their portion of the A/P. I have read on most major payer insurance sites their policy will not allow the billing of more than 1 A/P code to be billed w/in 10 months of each other_that's my only guess as to why they're denying ours as it's against the other provider office. Most all insurance sites say this is how you are to bill OB Transfer of care pts but they will deny bundled or max limit every time. Am I missing something here?? Is everyone requesting reconsiderations on these or appealing them every time?

 

[csperoni]

As long as the original OB practice billed correctly, you should each be getting payment for the portion you provided. Yes, you may need to appeal or send your documentation in order to receive your payment.
From what I have seen, it's often initially denied if both OB practices are billing the 59426 7+ visits, which would generally be an unusual situation anyway.

 

[centralizedcoding]

As long as the original OB practice billed correctly, you should each be getting payment for the portion you provided. Yes, you may need to appeal or send your documentation in order to receive your payment.
From what I have seen, it's often initially denied if both OB practices are billing the 59426 7+ visits, which would generally be an unusual situation anyway.

That's exactly what I was thinking would need to be done but was really hoping not bc we have so much volume that it's really hard to fight these but Im sure it'll get easier once I can find my groove. Thank you so much!