Wiki Antepartum billing

[jtyndall]

When billing out a 59425 we have always billed it using the last OB visit as DOS, 59426 we bill using the delivery date as DOS, we have not had any problems until recently, one payer (BCBS) started to require a date range (1st - last prenatal visit), if the new year somehow falls within the date range they are requiring a split claim, one ends on December 31, the new one starts January 1. We do not have an issue with any other payer. Has anyone had this same issue?

 

[sarahjanejones]

We bill Arkansas Blue Cross Blue Shield and, yes, they do require us to bill as you've stated. So, for example, if the patient had 12 visits total, 6 in 2014 and 6 in 2015 then we would bill 59425 x one unit (date range of first visit to date of last visit in 2014) and then 59425 x one unit (date range of first visit in 2015 through the last visit prior to delivery).

On a side note, nearly all of the payers we bill require/accept the antepartum care billed with the date range as the date of service (first visit to last visit).

Hope this helps

 

[jtyndall]

It does! Thanks so much for your input!