Wiki Billing Individual visits

[nklunk86]

I'm struggling to get commercial OB charges billed and paid. Sometimes after holding claims till delivery to bill a global they will go elsewhere to deliver. What is the best way to bill the individual visits? I tried bill the 59425 or 59426 with a date range and the units as how many visits were done but had one Anthem claim deny for filling limits as the beginning date was out of limits. Had another deny due to the units billed. Any help would be greatly appreciated. TIA

 

[csperoni]

When not providing the entire global package, you would split and bill for the services you did provide.
ANTEPARTUM:
1-3 visits are billed each visit at the level provided on the date of service
4-6 visits 59425 or 7+ visits 59426 are billed ONCE. If your payors require (mine don't), you would bill with a range of dates that covered all antepartum. If your payors don't require, I bill the 59425 or 59426 with a date of service for the last day seen.

If you are billing with pregnancy diagnoses, most carriers will pay even if not within their timely filing. It could require an appeal or extra phone call.

Keep in mind commercial carriers do sometimes set their own rules and policies that could differ. You should follow payor policies even if different than my general advice above.