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OB Billing Guidelines

  1. Default OB Billing Guidelines
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    I have two situations where the insurance is requesting we split out all antepartum charges by date and also bill the delivery seperate. On patient was not effective on her plan until OB had already begun and her insurance has requested we split out all antepartum codes by date. The second patient has insurance through a temp agency and her coverage could terminate on a week to week basis depending on if their is work that particular week so they have also requested all antepartum be billed out by date. I feel as though we are billing these OB services the way the insurance wants them and not based on correct coding guidelines. Is there any information or instruction stating that this type of "split" billing is allowed when the insurance carrier requests it ?

  2. #2
    We have several payers that require the maternity billing be split out by prenatal visits, delivery and postpartum visit - if we don't split it out like their policy states then we don't get paid. Unless you have a specific arrangement in writing with a payer on how to submit these claims I would bill them the way their policy states.

    Many of our OB patients switch/change/lose insurance during the course of their pregnancy. I go back through when they deliver to decipher what they had when and bill each payer accordingly by splitting out the charges. It is the most accurate and legitimate way to bill.
    Leandra Tufts, CPC, CEMC, COBGC

  3. Default
    If you enter normal visits-59420, in your system as a zero $ when patient is seen then it is easy to know how many visits by looking at your history on patient account. If they deny the claim when billing according to guidelines "59400 or59510 then simply use their appeal form online "or your own if you have one" and print a summary from your patient account that lists all services from first New OB visit to the last. If a payer requires this all the time then simply attach one to each claim when the original one goes out. I have never seen a fee schedule that has an allowed amount for a normal visit-59420. For extra help contact ACOG if you are a member, alot of the times they will have pre-printed letters that explain the billing procedures and guidelines that you can attach to any appeal. For example an assistant at cesarean delivery being denied, I received a letter and have been appealing when denied by some of the smaller self-funded groups, 90% of the time I have been successful.

  4. Smile OB Billing
    Thank you ladies for you help.

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