Wiki Billing 59425/59426 with Dates of both ICD9 and ICD10

[mbrock@fvwchp.com]

I am getting denials from specifically BCBS when billing the 59425/59426 with dates starting in ICD9 and ending in ICD10. They are telling us that we need to split the claim according to ICD9/10, but no other direction. So far this is the only carrier not accepting a single line of 59425/59426 with date spans of both ICD9/10. Is anyone else seeing this issue and how are your billing them?
Thanks,
Michelle

 

[mitchellde]

Are you trying you bill this as one claim? If so, you cannot it does need to be split.

 

[CodingKing]

I didn't think you would use a date span. If I'm not mistaken the DOS is the last date the person was seen for any partial global codes. Otherwise it would be impossible to split as you cant bill for each visit separately. It would cause overpayment. You don't get to unbundle because the span issue.

 

[mbrock@fvwchp.com]

You do need to bill to and from dates on the claim. Coding guidelines state that this should be a singe line with a date range. So if I split the claim, I would be billing two different claims with each claim having a 59425 on it. UHC did publish how they want you to bill, but so far, they are the only carrier I found a policy on.

Q: If a physician provides antepartum services when the “from” and “to” dates span across ICD-9-
CM to ICD-10-CM code sets, and global maternity service codes are used, such as CPT 59425 or
59426, how should the services be reported?
A: To facilitate correct payment and application of benefits in the UnitedHealthcare claims system,
when the date span crosses ICD-9-CM to ICD-10-CM code sets, the “from date” of service should
be reported with the correct ICD code from the applicable code set for that date of service.
Example: Report the diagnosis using the ICD code set that is in effect for the date of service in the
“from date” field. If the date in the “from date” field is on or before Sept. 30, 2015, use the ICD-9-
CM code. If the date in the “from date” field is on or after Oct. 1, 2015, use the ICD-10-CM code.
Note: Global maternity care codes for services that span over the ICD-10 effective date do not need
to be split on two lines to accommodate the implementation of ICD-10-CM. If an OB global code
REIMBURSEMENT POLICY
CMS-1500
Proprietary information of UnitedHealthcare Community Plan. Copyright 2016 United HealthCare Services, Inc. 2016R0064A
and/or antepartum services procedure code is reported on two or more claims by the Same Group
Physician and/or Other Health Care Professional, only the first unit processed will be considered, all
subsequent units will be rejected and not separately reimbursed.

 

[CodingKing]

Have you contacted BCBS?

 

[Kholloway]

I agree- the dates must be split.

 

[CodingKing]

I agree- the dates must be split.

That would be unbundling. These codes are not single visit codes. The only way to split would be to bill E&M code for each visit which will cause overpayment.

Id still say contact BCBS to see what they want done. Here is some information I found from BCBCS of GA

https://www.bcbsga.com/shared/noapp...rtiary/pw_e189487.pdf?refer=chpproviderbcbsga

One bill should be submitted for the entire global service.
Use the date of the service event (surgery or delivery) to determine the code set to use.
Service events that occur on or before 9/30/2015 should be billed with ICD-9 codes for the entire global service, including services (i.e. post-op visits) that occur on/after 10/1/2015.
Service events that occur on or after 10/1/2015 should be billed with ICD-10 codes for the entire global service, including services (i.e. pre-op visits) that occurred on/before 9/30/2015.
Do not bill any global codes separately, regardless of the service date.