Wiki billing out antepartum visits within the same group

[Vanessa123]

This maybe a silly question, but I would like clarification regarding how to bill out antepartum visits for physicians that are in the same group.

We have an OB group of 5 physicians. They all see their OB patients in the same office but during the patient's pregnancy they have to rotate seeing the patient at least once during their pregnancy. When the patient's visits have to be billed out it for various reasons for global insurance, do we bill out for each Dr that they seen or just the one code depending on how many visits they were seen all together (59425-26)?

My example is I have a patient that was coming to the group for her OB visits. She was seen by one of the Dr's 3 times and seen by another Dr for 1 time. A total of 4 visits. The patient had to have a D/C at another facility by another Dr due to complications with the baby.

My thinking is that I would bill out the 59425 for 4-6 visits under the Dr that seen her for the majority of the time. The issue has arrived that we should bill out for each Dr being they seen the patient. I am not sure if this is correct. Any suggestions?


Thanks in advance,

Vanessa

 

[bonzaibex]

You are correct. Pick a doctor & bill out the appropriate antepartum code once.

--Becky, CPC

 

[buttons4_4@hotmail.com]

I have a follow up question to this:
When billing in the same group for antepartum care and the providers see the patient equally:
DR. A sees patient 3 times and DR. B sees patient 3 times, we bill a 59425 for 4-6 visits, but which DR. do i bill it under if they both saw the patient for the same amount of visits? Thanks!

 

[csperoni]

I have a follow up question to this:
When billing in the same group for antepartum care and the providers see the patient equally:
DR. A sees patient 3 times and DR. B sees patient 3 times, we bill a 59425 for 4-6 visits, but which DR. do i bill it under if they both saw the patient for the same amount of visits? Thanks!

You may bill under either Dr. A or Dr. B.
I just would want it overall to be fair for both providers (particularly if their salary/bonus is tied to productivity or revenue. If ties always go to Dr. A, then Dr. B is being shortchanged. But if odd months you credit Dr. A and even months Dr. B or some other nonsense way to make it even (flip a coin, whatever), then it will average out in the long run.
If your organization is concerned about the productivity or revenue measurement, you will need to develop an internal way to track this.

 

[buttons4_4@hotmail.com]

You may bill under either Dr. A or Dr. B.
I just would want it overall to be fair for both providers (particularly if their salary/bonus is tied to productivity or revenue. If ties always go to Dr. A, then Dr. B is being shortchanged. But if odd months you credit Dr. A and even months Dr. B or some other nonsense way to make it even (flip a coin, whatever), then it will average out in the long run.
If your organization is concerned about the productivity or revenue measurement, you will need to develop an internal way to track this.

Thanks Christine. I usually follow up internally when it comes to RVU so they can track. I just wasn't sure if there were black and white guidelines on this specific scenario. Thank you for your reply!