Ob-Gyn Coding Alert

Question: What is the appropriate way to bill when a patient changes insurance in the middle of her pregnancy? Does the rule differ if we are talking about a state funded insurance? We have a lot of people who start out pregnant with insurance through their job, and then they become unemployed and have to get on state funded insurance halfway through their pregnancy. Sometimes they move to their spouses' policy.

Do you bill antepartum care to both insurances for the appropriate number of visits? Then vaginal + pp to the insurance held at time of delivery? OR do you bill global to the insurance that is held at the time of delivery as long as they have had enough visits under that policy to qualify for global?

Tennessee Subscriber

Answer:

The payer decides so you will have to ask them. The split care rules put forth by CPT^® do not deal with changes in insurance, so the insurance company must decide if:

• they want to pay you in full even if you have already been paid by another company
• they want you to use a modifier 52 (Reduced services) on a global code, or
• they want you to itemize the services.

Once you have this information, you will know how to submit your claim.