Wiki OB global billing

[colebk]

Good morning,
My ADD brain has made a mess of this case, so if someone can set me straight I would appreciate it. Pt saw us for 2 pregnancy visits with XYZ insurance in 2023 - they were already billed as individual E/Ms. We have now seen her with her new ins. for 11 antepartum visits, vaginal delivery, and PP care. I feel like a crazy person not billing this under 59400.

 

[mmckibbin]

Billing will depend on the insurance company guidelines. Some say if over X visits it will be global no matter what. Most will be split billed because you already started care and billed 2 other visits with a different insurance company.

 

[csperoni]

I agree with @mmckibbin. Almost all my carriers would want this split billed to new insurance
59426 7+ antepartum
59410 vaginal delivery with postpartum care

 

[rstroup]

I always seem to struggle with this. I have patient that had a total of 14 prenatal visits. She had Humana for 9 visits then her insurance changed to BCBS for the remaining 5 visits. The physician did not perform the delivery, only antepartum & postpartum care. So, do I bill Humana 59426 for 7+ visits and bill BCBS 59425 for the other 5 visits or since the majority of the antepartum was under Humana, do I bill global codes 0502F for those 5 visits and only bill 59430 to BCBS for the postpartum?

--
Ryan Stroup, CPC

 

[nielynco]

I always seem to struggle with this. I have patient that had a total of 14 prenatal visits. She had Humana for 9 visits then her insurance changed to BCBS for the remaining 5 visits. The physician did not perform the delivery, only antepartum & postpartum care. So, do I bill Humana 59426 for 7+ visits and bill BCBS 59425 for the other 5 visits or since the majority of the antepartum was under Humana, do I bill global codes 0502F for those 5 visits and only bill 59430 to BCBS for the postpartum?

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Ryan Stroup, CPC

Since you did not do the delivery, split bill this. If you had done the delivery, you would have billed insurance 1 for their visits, then could have billed global care for insurance 2 (if they allow it) with a modifier -52 for reduced antepartum services under their coverage policy responsibility.

 

[rstroup]

Since you did not do the delivery, split bill this. If you had done the delivery, you would have billed insurance 1 for their visits, then could have billed global care for insurance 2 (if they allow it) with a modifier -52 for reduced antepartum services under their coverage policy responsibility.

Thank you! That makes sense. Not sure why it wasn't clear to me before.

--
Ryan Stroup, CPC