Wiki CNM and Outside provider with CS, how do I bill globally?

[debellis59]

Hi All:

I'm about to go insane and I need some guidance. We recently were married to another hospital and thus had a change of Tax ID. Everything I read said to bill the antepartum care separately due to the TAX ID change. Well, that's not the case. Oregon Public Assistance wants it globally as does UHC. Whatever.

My problem is ... We have Midwives that took care of our OB patient, and when the delivery came up, an outside provider performed and billed for the C-Section. One of our Midwives assisted. So, our midwives provided the antepartum care, the assistance at CS, and the postpartum care. HOW do I code for that? It should theoretically be a global code, but nothing I can find supports billing 59510 for a midwife. So, I'm wondering if anyone knows if 59510-AS is appropriate???

Any help anyone can provide would be so appreciated.

Thank you,

Deb

 

[CBLENNIE]

CPT 59510 has a surgical assistant payment indicator of 1-"Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid." So, in theory, no you cannot bill 59510-AS, however we all know that Medicaid (and other public programs) and commercial insurance carriers often have different rules and may deviate from the correct coding of a procedure. Per UHC's Obstetrical Services Policy, Professional policy # 2023R0064C they will only allow an assistant surgeon to be billed with 2 CPT codes, 59514 & 59620, so it looks like UHC is following the coding guidelines for the surgical assistant on 59510.

I work for an insurance company, and we would expect the midwives to have at least 3 separate charges, antepartum care 59425(4-6 visits) or 59426(7 or more visits), delivery code c-section only 59514-AS or 59620-AS and postpartum care 59430. I assumed on the antepartum care codes that the midwife saw the patient for at least 4 visits, however if they only did 3 visits then you would bill the appropriate E&M codes for each date of service.

 

[debellis59]

CPT 59510 has a surgical assistant payment indicator of 1-"Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid." So, in theory, no you cannot bill 59510-AS, however we all know that Medicaid (and other public programs) and commercial insurance carriers often have different rules and may deviate from the correct coding of a procedure. Per UHC's Obstetrical Services Policy, Professional policy # 2023R0064C they will only allow an assistant surgeon to be billed with 2 CPT codes, 59514 & 59620, so it looks like UHC is following the coding guidelines for the surgical assistant on 59510.

I work for an insurance company, and we would expect the midwives to have at least 3 separate charges, antepartum care 59425(4-6 visits) or 59426(7 or more visits), delivery code c-section only 59514-AS or 59620-AS and postpartum care 59430. I assumed on the antepartum care codes that the midwife saw the patient for at least 4 visits, however if they only did 3 visits then you would bill the appropriate E&M codes for each date of service.

Thank you. I suspected I'd have to break it down. I appreciate your response.