Wiki Antepartum care

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drufolo

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Having problems with UHC on antepartum care codes
We sent in claims with the 59425 for 4-6 visits
and 59426 for 7 or more.
They denie it because they said it shows only (1) unit in our system we put the beginning date (ie 5-31-11 thru 11-10-11) they state they need separate dates. If we put in the more than 1 unit it increases the charge. We have also sent in the flow sheet showing the visits. What do you suggest.:confused:
 
When they require us to list the dates seperately, we use 59425 list the dates seperately and divide the total charge by the number of dates. We then use that as the fee for each date.
For example lets say we charge $800.00 for 59425 divide that by 4 visits = $200.00 each visit.
Hope that helps.
 
I haven't done this in a while, but I think if you put the last visit date for the codes, example 59425 for 11/10/11, then list out the dates in box 19, I believe the claim was paid.
 
Any word on how BCBS wants this? I need to bill for 4 antepartum visita but not sure if I need to list them out by each date or bill 4 units. Any help would be appreciated.
 
Any word on how BCBS wants this? I need to bill for 4 antepartum visita but not sure if I need to list them out by each date or bill 4 units. Any help would be appreciated.
 
My experience with BCBS has been they want global charges even though it isn't correct. However, of you are going to bill for antepartum care 59425 for the 4 visits use 1 unit, but in box 19 of the HCFA put the dates seen. You may have to appeal, depending on how BCBS wants to process the claim.
 
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