Wiki split billing for ob care

[jebond123]

I would really appreciate some input on this dilemma:
Patient started care with our doc at 16 weeks in August 2022. She had a total of 12 prenatal visits and our doc delivered her (nsvd) on 2/10/23. Six of her visits were in 2022 & six were in 2023.
#1 could this be considered global billing due to the number of prenatal visits?
#2 if not, do I have to split up the antepartum care into two separate claims for each year?
#3 can the same provider bill antepartum (59425 in each year) twice?
Any advice is very much appreciated.
Janet

 

[csperoni]

Some of this can depend on the policy of the payor. I have seen varying guidance from payors for less than 13 visits.
Another big factor can be whether or not the patient received obstetrical care from another provider prior to 16 weeks. Carriers do not want to pay one provider global maternity, and then ALSO pay another provider for ob care.
If the patient did not have other ob care, unless the carrier states MUST be 13 or more visits, I would consider this global maternity and bill 59400.
If you do need to split bill, it does not need to be per year. You would bill 59426 for 7+ antepartum visits and 59410 for vaginal delivery plus postpartum care.
Regarding #3, unless it is different pregnancies, you would not bill 59425 twice. If patient had >6 visits for the same pregnancy, you would bill 59426 for 7 or more visits if split billing. So while it is feasible to bill 59425 twice, that would not be the case for this scenario.
Hope that helps!

 

[jebond123]

Some of this can depend on the policy of the payor. I have seen varying guidance from payors for less than 13 visits.
Another big factor can be whether or not the patient received obstetrical care from another provider prior to 16 weeks. Carriers do not want to pay one provider global maternity, and then ALSO pay another provider for ob care.
If the patient did not have other ob care, unless the carrier states MUST be 13 or more visits, I would consider this global maternity and bill 59400.
If you do need to split bill, it does not need to be per year. You would bill 59426 for 7+ antepartum visits and 59410 for vaginal delivery plus postpartum care.
Regarding #3, unless it is different pregnancies, you would not bill 59425 twice. If patient had >6 visits for the same pregnancy, you would bill 59426 for 7 or more visits if split billing. So while it is feasible to bill 59425 twice, that would not be the case for this scenario.
Hope that helps!

Thank you