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Splitting Antepartum Visits

  1. Question Splitting Antepartum Visits
    Medical Coding Books
    Is there any documentation of the other than the break down by visit for antepartum care? I have an issue where I believe that it might be considered double billing.

    Can you bill out the code 59426 (7+) visits if 3 of those visits have already been billed out and paid by the insurance company? I would bill out a 59425 to cover the visits that were not submitted. Am I wrong in my thinking?

  2. #2
    Location
    Idaho Falls, Idaho
    Posts
    197
    Default
    My first question is why were the first three already billed out? If it was for problems, then they are seperate from the global package, and you would only bill out for the routine ob visits. Don't count the visits already billed and paid. Count the routine visits and bill out how many there are.
    Tesja Erickson, CPC, CPMA COBGC, CEMC
    The Coding Surgeon
    Medical Documentation & Coding Consultant
    codingsurgeon@tesja.com
    2012 AAPC Idaho Falls Chapter President
    2011 AAPC Idaho Falls Chapter President-Elect

  3. Default
    Thanks for replying. This clinic routinely bills out the first new ob appointment with u/s codes 76801/76817 dx V28.1, V22.0 and Q0091 V76.2. The patient is also told at the beginning of the pregnancy that this dos, her targeted u/s at 22-26 weeks and any lab work will be billed out separately. We don't have any problem with these being paid. My problem has to do with the clinic wanting me to include these paid visits in the count for the antepartum care. Unless I can find some information somewhere that states that what they want me to do is correct then..I'm afraid my job is in jeopardy.

  4. #4
    Default Expert opinion.
    Hi Dawn,
    I am also waiting to hear the thoughts of experts on this question. Thanks for posting such nice question here.
    Experts should share their descriptive thoughts on this question.

    Quote Originally Posted by DawnMichille View Post
    Thanks for replying. This clinic routinely bills out the first new ob appointment with u/s codes 76801/76817 dx V28.1, V22.0 and Q0091 V76.2. The patient is also told at the beginning of the pregnancy that this dos, her targeted u/s at 22-26 weeks and any lab work will be billed out separately. We don't have any problem with these being paid. My problem has to do with the clinic wanting me to include these paid visits in the count for the antepartum care. Unless I can find some information somewhere that states that what they want me to do is correct then..I'm afraid my job is in jeopardy.

  5. #5
    Default
    Are you not billing globally then, antepartum, delivery, and postpartum?

    We bill a COP, which is the initial visit, separately from the global. US, NSTs, and problem visits are also billed separately. All other visits are considered part of the global.

    If you are providing antepartum care only, you don't count the first visit, as your policy already states that this is a separate charge. If you bill separately, then count it again as a visit to determine the antepartum code, I feel that that is double billing for that visit. Only those visits that are considerd part of the routine global should be counted should determine the antepartum code, and that is how I bill antepartum only services.

  6. #6
    Default
    Do you append a 24 or 25 to any of the visits that are billed outside of the global?
    Thanks
    PeaPod

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    We code an E/M for the COP (confirmation of pregnancy) but only if the OB flow record is not started. The second that is started, you are in global. We do bill out separately for complications during the pregnancy, but unfortunately reimbursement is an issue depending on the insurance carrier. You can also bill separately for any observation or inpatient stays during the pregnancy due to complications.

    As far as the initial question, if the OB flow record was started at the first referenced visit, you should not be charging outside of global regardless of what you tell the patients. Also, the scenario presented kind of muddies the waters and you may be opening the door for an audit or at the very least insurance take back until you appeal appropriately.
    Lisa Bledsoe, CPC, CPMA

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