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OB Billing when payers change during pregnancy

  1. #1
    Default OB Billing when payers change during pregnancy
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    I have a question regarding OB Billing.....

    OB provider provides all OB care (antepartum, delivery and postpartum) to a client and the client switches between managed care plan/FFS coverage throughout their pregnancy. When a provider provides all OB care they should code the OB global codes (59400, 59510 or 59610), but billing gets complicated when the payer changes throughout pregnancy. In my perspective, the provider should code and bill the services to the plan that was active when the services were provided. Rather than billing the OB global code to the payer, that was active on date of delivery.

    The question is how should the provider have billed when the payers change during the pregnancy?


    Willie V. Oregon Medicaid

  2. Default
    In my opinion you are correct, we have always billed to the payer the patient was active with. If the patient changed payers we would charge out to the prior payer what ever services had been rendered and then continue to charge visits to the new payer according to their billing requirements. Medical assistance payers usually have us charge each visit and service separate, Prenatal-delivery-post partum, so charging the global code at delivery does not always work. If a patient has MA HMO and we charge the global code, the charge will be denied.

    Reinhard B. Pennsylvania

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