Multiple phys OB and billing deliveries

aalsabrook

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I need help on resources for this question. I am a coding manager for a large multi specialty organization and in our OB line of services, there is an understanding that If there is more than one provider billing under the same tax i.d., and one performs the ante partum services but another performs the delivery, that the antepartum phys can bill the 59426 and the delivering phys can bill the 59409 or 59410. I think this is unbundling and that we can not do it but I have had several others who have worked in OB offices before who say that we can and one who has done this for years.

Can anyone clarify the rules that say you can or can not do this?
 

sknapp56

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When coding for a muti physician practice the guidelines are 1 tax ID number equals 1 physician. How we do it is one physician gets credit for the global OB package and the second provider would get credit for his services but it is done internally. I have posed this question before and the responses were in agreement with this. The only time you break up the global billing is if there is an insurance change or transferring in or out of care. Hope this helps.
 
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Chehalis, WA
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I have a similar question. We are under one tax ID#,however, if provider A saw the patient for all antepartum care, then Provider B delivered, provider A gets 59426 and provider B gets 59410(vaginal)..Now, what is provider C saw the patient one time due to provider A being out on vacation. Do you submit E/M with TH modifier for the one visit?
Or, what if Provider A did see patient for all antepartum and delivery, 59400, but Provider C still saw the patient for one visit, we cannot bill the global then to Provider A..........
 

alarson

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Brownsville, OR
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When providers work in the same group practice, then they should not split the billing like this. Since they work in the same group practice, they are expected to cover for each other and should not break up the global package when this happens.

If you want back up to show your providers, I would suggest going to ACOG's website (American Congress of OB/GYN). On their site you can email coding questions to them for free. It does take quite awhile to recieve a response but they are a good place to go to for back up.
 
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