Wiki Correct way to bill for OB care with 2 different insurances

[bkegler]

I've been an OB coder for almost 7 years. At my new employer they've asked me to correct some charges that I'm questioning. If you can let me know the proper way to bill this scenario, I would appreciate it.
Pt has UHC effective 7/1/2020 (primary) and also started Medicaid 11/1/2020 (secondary). Pt has had her entire OB care with us and her first visit was 9/9/2020 and second visit was 10/12/2020. We delivered her end of March and her postpartum visit is coming up. I billed the global OB code to her primary insurance because it covers her entire care with us. My manager said I billed it wrong and that I should split out the OB care due to the secondary insurance starting 2 months after her initial visit. She told me I should bill the first two visits as E/M and then the rest as antepartum (59425/6) and then the delivery + postpartum care code. She said it's because Medicaid won't cover the global due to the first two visits. But to me, that's incorrect coding.
Could someone confirm or correct how this situation should be billed? I would really appreciate it.

 

[RABBIT2020]

I do not know about Medicaid policies. I work on commercial payer policies. However, just hypothetical if we replace medicaid with another payer say for instance Cigna then you would bill Global for UHC because the new policy Cigna became effective after the delivery.

 

[nrood]

I definitely would not split bill based off the secondary payer. You are correct. That is incorrect coding. If the patient lost the UHC and had only Medicaid, then you would bill first portion of split to UHC and individual visits to Medicaid. (Because Medicaid only pays delivery only codes they pay for each individual visit by trimester with appropriate U9 or U8/HD modifier.) However, that does not sound like your scenario. Other things to consider, how many antepartum visits prior to delivery? Were there about 13 visits? If yes, global bill. Besides, the fee schedule for UHC pays more than you'll ever get for Medicaid. Why would you want to cheat yourself out of money??