Wiki OB/GYN - Billing with mutiple CMO's

[SMcConnell0421]

Please advise the correct way to submit this claim. I'm getting conflicting information.

Patient was "Self Pay" for her first 4 visits then recieved state Medicaid for 4 visits then the state medicaid changed her to a CMO and she had 5 visits the delivery and postpartum under the CMO.

Do I bill the state medicaid E/M codes or the 4-6 visit antepartum? (59425) plus

Do I then bill the CMO E/M codes or an addition 4-6 visit antepartum, then delivery and postpartum separate? (E/M's x 5, 59410) or (59425, 59410) plus the first 4 visits (59425)

It was my understanding that only ONE antepartum could be billed PER PREGNANCY.
If so, I would bill- 59425, 5 x E/M visits and 59410?

Thank you for your help.

 

[tpkeith]

In Georgia, we would bill Medicaid 4-6 antepartum (59425)
- CMO 4-6 antepartum (59425) AND delivery (59410)

If there was a break in coverages, there is no other option than to bill two antepartum codes. It would be the same if a patient was seen elsewhere for part of their obstetric care. I know of no regulation stating you can only bill one antepartum code.
Teresa Keith
North Georgia Women's Center
Dalton, GA

 

[tpkeith]

In Georgia, we would bill patient self pay 4-6 antepartum (59425)
- Medicaid 4-6 antepartum (59425)
- CMO 4-6 antepartum (59425) AND delivery (59410)

If there was a break in coverages, there is no other option than to bill three antepartum codes. It would be the same if a patient was seen elsewhere for part of their obstetric care. I know of no regulation stating you can only bill one antepartum code.
Teresa Keith
North Georgia Women's Center
Dalton, GA