Wiki Billing prenatal claims

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Shortcakecoder101

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Hi all, I have a pretty extensive question and could really use some help! Our docs just started billing for prenatal services, prior to that the hospital was doing it so we were not able to do the deliveries. Now that we've taken over the prenatal patients aren't we supposed to look for the deliveries and bill them? My manager is telling me this is incorrect that I should just bill the initial, subsequent and pp claims. Also I'm having a difficult time trying to get the dr's to stop billing 59425 and 59426 for the antepartum visits. I appreciate any help!!!


Thanks!
 
If you are providing prenatal, delivery, and postpartum care you should be billing the global codes. Or is there more to the situation?
 
Hi, thank you for your response. I think I'm a little confused. I was taught not to use 59425 or 59426 unless the patient either switched care during her pregnancy or if the patient's insurance changed during that time too. I was told I can bill code 59430 one time if the visit is right after her delivery for Medicaid patient's. Initial OB visit 0501F, subsequent 0502F and pp 0503F, is this correct? So if the patient starts her care from the initial visit to the pp what code do I bill? I guess what I'm getting at is I'm being told not to bill the delivery only 0 codes. When is the appropriate time to bill for 59425 and 59426? And what are the global codes I should be using? This is very confusing me so I really appreciate your help!!! Thanks Colleen
 
Your original question did not mention Medicaid. Medicaid is administered by the states, and each state has certain leeway to administer their programs. To get good information, you'll need to tell us what state you're in, and if this is traditional Medicaid or a Medicaid HMO plan.

Generally (not speaking to any specific type of insurance), if you perform all of the prenatal, delivery, and postpartum care, you'll be billing a global ob code. Here is one article that explains this.

If you don't perform all three of those components, there are other codes that are not global.
 
Thank you again for your response. This is in the state of New Jersey and it's both Medicaid and Medicaid HMO. For Medicaid and the HMO's should the cpt codes be billed as 59425 and 59426. The way my manager is telling me how to bill these claims is by the coding guidelines and not by how the insurance wants it billed. I always thought claims were billed according to the insurance company. Could you tell me how antepartum fit into this please? I'm just being told so many different answers on how to do this. I will read the article, thanks again!!!
 
Sharon Collachi is correct. You need to look at your state's Medicaid Provider Manual. It will tell you how they REQUIRE you to bill for prenatal, delivery and postpartum care. If the directions are different from the way your manager tells you, you can then provide proof. If your office does not have a Medicaid Manual, they are usually online. Coding guidelines are just that - guides. Every insurance decides what they will follow according to the guidelines and what they will change to suit their needs. In my state medicaid requires every prenatal visit to be billed separately and then delivery billed as 'delivery only' and then 2 postpartum visits which are each billed separately. Medicaid HMO's usually follow the state Medicaid guidelines but again to be sure you would need to contact them. Commercial insurance will follow the global ob coding rules as stated previously by Sharon.
 
Yes, how you explained it is how I was taught to do it. Every visit is a 99 code, delivery and pp. Could you please tell me how 59425 and 59426 comes into play?

Thanks so much!
 
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