Wiki Billing Global fee when Insurance changes in the middle of the pregnancy

[robinski84@yahoo.com]

Hi, I am wondering about how to bill a patient's insurance if it changes in the middle of her pregnancy. If the patient has 7+ visits, delivery, and PP with her insurance that took effect in the middle of her pregnancy, do you still bill the previous lets say 7 visits to her previous insurance?

Example:

59426 to Anthem & then 59400 to Optima

OR would you split it like this?

59426 to Anthem

59426 to Optima - for 7 Prenatal visits
59410 to Optima - for the vaginal delivery + PP

Last question... If you do split and bill Anthem and Optima separately do you bill out 59426 to Anthem as soon as the insurance charges or do you wait until the end of the pregnancy?

Thank you!!

Robin Skievaski, CPC

 

[csa2020]

Hi,
59426 to Anthem - provided 7 or more Antepartum visits was done. As long as all dates of service was done during the patients active policy with Anthem.

59410 to the new insurance since it includes delivery and PP care. Any Antepartum visits during the active policy of the new insurance needs to be billed too.

Of course, All Ultrasounds get billed separately to the active insurance on that date of service.

I bill Antepartum visits ASAP. Mostly to avoid any "timely filing" from the insurances. 59425 or 59426 depending on the number of visits. If under 4 then I bill E&M visits for those dates of service.

I hope this helps.

Carolyn, CPC-P