Ob-Gyn Coding Alert

Question: I’ve been an OB coder for almost 7 years. At my new employer they’ve asked me to correct some charges that I’m questioning. If you can let me know the proper way to bill this scenario, I would appreciate it.

Pt has UHC effective 7/1/2020 (primary) and also started Medicaid 11/1/2020 (secondary). Pt has had her entire OB care with us, and her first visit was 9/9/2020 and second visit was 10/12/2020. We delivered her end of March, and her postpartum visit is coming up. I billed the global OB code to her primary insurance because it covers her entire care with us. My manager said I billed it wrong and that I should split out the OB care due to the secondary insurance starting 2 months after her initial visit. She told me I should bill the first two visits as E/M, then the rest as antepartum (59426), and then the delivery + postpartum care code. She said it’s because Medicaid won’t cover the global due to the first two visits. But to me, that’s incorrect coding. Am I right?

North Carolina Subscriber

Answer: If United Healthcare (UHC) was primary for her entire pregnancy, then bill the global (such as, 59400, Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care)) to UHC.

You will, however, carve out the services rendered under the Medicaid secondary (and only bill them for those services). You should definitely check with your Medicaid rep (or your policy manual) as most do require the carve-out for only covered services on the date of service. More work for you in billing, but the advice you were given by your office is not correct, and you risk a denial from UHC as primary if they require global billing.