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OB Global Billing - insurance companies

  1. Default OB Global Billing - insurance companies
    Clearnace Sale
    I have a patient who has changed insurance companies during her pregnancy. She became a new OB patient on 10/25/07 and has had 9 visits during her coverage under 'Plan A'. Effective 4/1/08 she will be covered under 'Plan B.' Her expected date of delivery is May 3,2008. At this point, I am assuming she will be seen for at least 4 visits under 'Plan B.' I am not sure how to bill the visits to 'Plan A' for her 9 antepartum visits. Should I bill CPT 59426 to 'Plan A' and the delivery code 59400-52 to 'Plan B'? (I am appending modifier -52 to 'Plan B' insurance since she will be seen for less than 13 antepartum visits). Naturally, these claims will not be filed until after her delivery. Please advise and thanks in advance!

  2. Default
    You will go ahead and bill the first insurance now for the number of visits, in this case being 9 it would be 59426. After her delivery you will need to bill the antepartum separate from the delivery using either 59425 (4-6) or 59426 (7+) or if under 3 antepartum visits each will need to be billed individually. Then you bill for the delivery with post partum only. You will not use a global delivery code with -52. Hope this helps.

  3. #3
    I concur with the billing before she delivers - but you should bill plan B for a total ob care because this is not part of the same Payer but a completely new service.

  4. #4
    salem nh chapter
    You should bill ins co A for the 9 visits 59426--once the pt delivers you would bill ins co B for the amount of prenatals (59425 for 4-6 or 59426 for 7 + visits). The delivery would be billed as 59410 vaginal delivery plus postpartum or if c/section you would bill 59515 for delivery plus postpartum. Hope this answers your question.

  5. #5
    Question Another question about this scenario
    In billing antepartum care only,, the 59426 or 59425,, how do you go about choosing which visit to use as the date for your service? I would think the first visit, but then when you bill it you run into timely filing and what not,, so should it be the last date of service instead that you use for billing the antepartum charges?

  6. #6
    Default anteparteum
    I use the last visit date during the effective time of the insurance with plan A... Some insurance however do want to know the exact dates of the visits so sometimes these have to be noted and the claim sent hardcopy with those dates noted. Hope this helps. Lucy

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