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OB Global Billing Question

  1. #1
    Default OB Global Billing Question
    Medical Coding Books
    Jane Doe had Blue Cross until 12/31/06. She switched to Kaiser on 1/1/07. She had 6 visits in 2006 while covered by Blue Cross and 8 visits plus delivery in 2007 while covered by Kaiser.

    My thought process is to bill a partial prenatal global to Blue Cross for the 6 visits in 2006. Then bill a full global including delivery to Kaiser since she had more than 3 prenatal visits + delivery in 2007.

    Need some advice ASAP!


  2. #2
    Tacoma, WA
    I don't believe you can bill antepartum to one and then a full global to the other regardless of the change in years. If you break out the global fee then you can only bill the appropriate antepartum to each insurance and then the delivery to the one responsible for delivery.
    Arlene Smith, CPC, CCS-P

  3. Default
    You have to bill BCBS for the 6 visits, CPT, 59425, Kaiser for the 8 visits, 59426 and then bill delivery plus PP to Kaiser for the delivery.

  4. Default
    Full global billing is full global billing. You cannot bill separately for prenatal services from the previous year.

    Based on my OB coding experience, I would bill the full global billing only to Kaiser; 59400 if vaginal or 59510 if cesceran.

    If the patient only had one insurance company through the whole pregnancy you wouldn't think of billing them twice, right?

    Jennifer Gauger, CPC

  5. #5
    I've been doing ob/gyn coding for years, and you cannot bill globally. You have to break it down, due to insurance changes and same provider.
    You would bill BCBS 59425 with a unit of 6; then bill Kaiser 59426 with a unit of 8. For the delivery you would either use the 59409 for vaginal or 59514 for the c-section. Postpartum will be billed separately.
    Best of luck to ya.

  6. Wink
    I agree with monotoyag. In my many years of obstetrical coding the ob needs to be split out. Bill BCBS 59425 w/6 units with the dates to and from, 59426 w/8 units with the dates to and from to Kaiser and then bill also the ob delivery w/PP visit. This happens when patients switch insurance carriers all the time, most insurance companies require you to split it out especially when they know that the patient had prior coverage with another insurance company.

  7. #7
    Agreed - you need to split the billing between BCBS and Kaiser.

  8. Default ob global question
    So what if Jane Doe has 5 AP visits to one government insurance and 8 Ap, 1PP and the delivery to another government insurance? example, Care Oregon and Cawem?

    Do you bill the global to the current insurance, since they are both government insurances or do you break up the global? Please give me sights with guidelines to this issue, if possible.

    Thanks a ton

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