Billing California Medi-cal

Tammy Hughes

Grass Valley, CA
Best answers
I am new to billing OB/GYN Medi-cal for California, and am finding there are so many rules and modifiers needed. I was wondering if anyone had some helpful resourses. Their web page is unhelpful. Especially information on 59400, 59510 and BTOs.
Tammy Hughes, CPC
Practice Manager
Richard M. Goddard, M.D.

Hello Tammy,

Yes, there are many rules in the State of CA with OB/GYN procedures. One way to get all the information is to attend their Medi-Cal Seminar. There is one coming to Ontario soon. Attend all of the HAP and OB/GYN Classes. There is also a claims room set up where you can receive live support. I alsways attend and take my questions with me. It is FREE!

Hope this helps.... Good Luck.
Joseph Newsome
I found this info on whay modifier to use when billing for

Global OB claims (CPT-4 codes 59400, 59510, 59610 and 59618) must be billed in the “from-through” billing format (called “from-to” on
the CMS-1500) with modifier AG (primary surgeon). The “from” date
of service is the first date the recipient was seen for this pregnancy, and the “through” or “to” date of service is the date of the delivery. Enter a quantity of “1” in the Days or Units field (Box 24G).

Hospital Services
99221-99223 Initial hospital care codes

These are the "initial hospital care" codes used by family physicians for coding their admission history and physical services for hospitalized patients. The global codes (59400, 59510) do not include initial or subsequent hospital services by the physician if the patient does not deliver. Physicians should code admissions (in-patient or out-patient) for false labor, out-patient PG gel, stress tests or medical/surgical complications separately.

The criteria used for utilizing these codes with a maternity care patient are absolutely no different than any other patient; however, a physician cannot use these codes in conjunction with the global codes 59400 or 59510, as the global codes already include initial hospital care for the patient who delivers.

Also check out thi8s website as it gives some goon info:

Good Luck!
I just went on-line to Mcal website and got the following link for you to view.–+Obstetrics+(OB)&wPath=N

The page I found shows the OB section in the Mcal, Part 2 Manual. There are tabs for all OB services and you can click on the one you want to read about.

My last coding position was for an OB/GYN and the thing that was the trickiest was the special modifiers Mcal required and all of their guidelines. So many rules! Good Luck!