Wiki Delivery w/10 antepartum & postpartum care

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Karajag

Karajag

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Local Chapter Officer
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Buffalo
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Looking for some clarification on how to bill the following after we received an ins denial: patient transferred to our care from another practice which billed CPT 59425 to her ins. We saw the patient for 10 prenatal visits, did the delivery, and saw her for her postpartum visit.

I reached out to the ins (which is a local) to check their policy for billing this due to the denial which stated that the "benefit for this service is included in the payment for another" and the rep I spoke to had no idea on what their policy for this situation is or where to find it, and only recommended that I submit an inquiry with supporting documentation. Does anyone have any insite to how this should have been billed, or recommendations on where to find the info? This is a new one for me and I thought I had notes for this type of issue but I can't seem to find them!
 
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You don't say what you billed - did you try to bill the global? In that case, you can't bill the global when there is a transfer of care; you would need to split bill.
 
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Just found my answer in the Specialty Coding book and came here to edit the post lol. I swear I looked at it this morning and never saw a thing. I will be blaming the jet lag for my lack of seeing it right in front of my face....

Global was billed originally. Will be sending a corrected claim with modifier 52 added.

Thanks for the assist!
 
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Karajag said:
Just found my answer in the Specialty Coding book and came here to edit the post lol. I swear I looked at it this morning and never saw a thing. I will be blaming the jet lag for my lack of seeing it right in front of my face....

Global was billed originally. Will be sending a corrected claim with modifier 52 added.

Thanks for the assist!
Click to expand...
I would verify the payer's policy. UHC, for example, wants it split billed in this situation. Here is an old post on the subject too https://www.aapc.com/discuss/threads/global-ob-transfer-of-care.182343/
 
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Karajag said:
Just found my answer in the Specialty Coding book and came here to edit the post lol. I swear I looked at it this morning and never saw a thing. I will be blaming the jet lag for my lack of seeing it right in front of my face....

Global was billed originally. Will be sending a corrected claim with modifier 52 added.

Thanks for the assist!
Click to expand...
I'm very new to this - can you tell me which codes you ended up submitting and which you added the 52 to? Thank you.
 
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