Wiki Antepartum dates overlapping coverage dates of insurances

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muqeetah

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I'm hoping to get some help. I have a patient that I need to bill antepartum on (we did not deliver) but I would have to split the 59425/59426 due to insurance coverage. Patient had BlueCross from Jan 2024 to July 2024, in that time span she got Medicaid for dates May 2024to August 2024. May to July 2024 pt had BC and Medicaid. I'm unable to bill two antepartum packages to the same insurance. I'm wondering if anyone has come across this scenario? Any advice would be helpful.
Thank you...any ideas will be appreciated!!
 
Assuming BCBS is primary to Medicaid secondary between May and July, I would bill antepartum to BCBS once for the visits from January to July (since the primary insurance does not change during this time period). Then bill Medicaid for the visits in which she only had Medicaid (August).
 
Thanks for answering my post. I'm still not sure what to do with the overlapping period when she had BC prime and MCD secondary. I understand that I can bill an antepartum package for BC during the time they were in effect as the only insurance, but I don't know how to report the dates when she had both BC and Medicaid? I can't bill out 3 antepartum packages (one to BC when it was the only insurance, one to BC/Medicaid, when they overlap, and another Medicaid when they were the only insurance.). This patient had BC only, then she got Medicaid, so she had BC and Medicaid, then lost BC and had Medicaid only. I don't think I can bill out all three even though she did have 3 insurance scenarios. Help!!
 
I'm trying to figure out how I would code the services, but I would need to know how many total visits the patient had from January 2024 through August 2024, and what are the dates of service?

Then I would break it down based on the 3 different periods of coverages, January 2024 - April 2024 (BC coverage only), May 2024 - July 2024 (BC & Medicaid coverage) and August 2024 (Medicaid coverage only).

If you can provide this information, I might be able to help you figure out how to bill this as I work for an insurance company in Idaho.
 
We only report a date span for UHC but maybe that differs by state. In any case, if Blue Cross was primary for Jan - July, regardless of any secondary insurance, wouldn't you use the first and last dos during that period?
 
Yes, but she got Medicaid for only part of the date span.
To answer CBLENNIES question:
The dates of visits are: 01.05, 01.16, 02.05, 02.13, 03.07, 04.11, 05.09, 06.06, 07.01, 07.10, 07.31, and 08.08 of 2024.
The patient has BC only for dates from 01.05 to 07.10. Then BC prime and Medicaid as secondary form 05.09, 06.06, 07.01, 07.10 of 2024. Then Medicaid only for 07.31 and 08.08.
Some of the dates overlap due to insurance effective dates. BC termed 07.31.2024, Medicaid effective 05.01.2024, so they overlap for 05.09, 06.06, 07.01, 07.10 of 2024. Any help or insight on this would be most helpful!!
 
muqeetah said:
Yes, but she got Medicaid for only part of the date span.
To answer CBLENNIES question:
The dates of visits are: 01.05, 01.16, 02.05, 02.13, 03.07, 04.11, 05.09, 06.06, 07.01, 07.10, 07.31, and 08.08 of 2024.
The patient has BC only for dates from 01.05 to 07.10. Then BC prime and Medicaid as secondary form 05.09, 06.06, 07.01, 07.10 of 2024. Then Medicaid only for 07.31 and 08.08.
Some of the dates overlap due to insurance effective dates. BC termed 07.31.2024, Medicaid effective 05.01.2024, so they overlap for 05.09, 06.06, 07.01, 07.10 of 2024. Any help or insight on this would be most helpful!!
Click to expand...
Right, so we only code for primary insurance. If I were billing this, I would bill 59426 to BC for Jan 5-July 10. And then E+M for the two dates that were Medicaid only/primary.
 
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