Wiki Coding for preterm delivery in 2nd trimester

[lsilbaugh]

Hello!

Patient went into labor at 26 weeks and delivered. I understand that would not fall under global, so the antepartum codes would be used, but would i apply vaginal delivery with pp care or do I unbundle everything?

 

[Cmama12]

It depends on insurance and also your organization's policies. Generally Medicaid would be split into the three codes. For commercial - I code for two states -same overall organization but locally under two different names/organizations - In one, we split into the three codes when not global; in the other it's the two codes.

 

[nielynco]

It depends on insurance and also your organization's policies. Generally Medicaid would be split into the three codes. For commercial - I code for two states -same overall organization but locally under two different names/organizations - In one, we split into the three codes when not global; in the other it's the two codes.

Or if permitted you can bill globally with a modifier -52 to reflect fewer than expected antepartum visits.

 

[lsilbaugh]

It depends on insurance and also your organization's policies. Generally Medicaid would be split into the three codes. For commercial - I code for two states -same overall organization but locally under two different names/organizations - In one, we split into the three codes when not global; in the other it's the two codes.

Yes we do that as well. the split codes for Medicaid. This is a commerical insurance, so it would fall under global. I will apply the modifier 52 to 59400

 

[mmckibbin]

I disagree with the -52 modifier. You still did everything for a normal pregnancy, did all the same tests and probably saw her at least 4 times. I would just bill the global delivery without the modifier.

 

[csperoni]

I disagree with the -52 modifier. You still did everything for a normal pregnancy, did all the same tests and probably saw her at least 4 times. I would just bill the global delivery without the modifier.

It depends on payor policy, but some require a specific minimum number of visits to bill global. I am not aware of any carrier accepting only 4 antepartum as meeting global maternity requirements. Depending on payor requirements, I would either (as already suggested by @Cmama12 and @nielynco) :
1) split bill the antepartum, then delivery plus postpartum.
or
2) global -52

It would be different if patient delivered 3 weeks early in which case you provided a lot more antepartum care than this scenario.

 

[mmckibbin]

It depends on payor policy, but some require a specific minimum number of visits to bill global. I am not aware of any carrier accepting only 4 antepartum as meeting global maternity requirements. Depending on payor requirements, I would either (as already suggested by @Cmama12 and @nielynco) :
1) split bill the antepartum, then delivery plus postpartum.
or
2) global -52

It would be different if patient delivered 3 weeks early in which case you provided a lot more antepartum care than this scenario.

You still did her entire pregnancy though. Even if she delivered preterm, your office took on the risk for that pregnancy. If you submit records to the insurance payer they will see that you were her dr's office the entire time. As long as it's past 20 weeks and you can bill for a delivery the insurance won't accept a split bill.