Wiki Global billing help

[jcisne]

Hello all!!

I have a patient who has switched insurances in the middle of her pregnancy. I am billing the 59426 but need to know if this code includes the delivery?? I am being told that I can bill 59425 for the BCB policy which patient had first and 59426 for the Coventry policy patient changed to mid-pregnancy. Then bill for delivery only. Any advice would be much appreciated!!

 

[pzoito]

Global

My advice would be to unbundle the global package. If the patient was seen 1-3 visits bill the level of E&M. If patient was seen for 4-6 visits bill the 59425, or if seen for 7 or more visits bill the 59426. You may want to contact both payers to see what they may require. When the patient delivers you should bill for the delivery and pp care if the service is performed by your providers, and the appropriate number of visits for antepartum care. Hope this helps.

 

[arrana]

I have a very similar situation. We only provide prenatal care, so we never bill for the delivery anyway. But our patient had the first 7 visits of her prenatal care under insurance A, and the remaining 4 visits under insurance B. I'm not sure if it is appropriate to split the billing between the two insurances with billing the 59426 to insurance A for the 7 visits, and 59425 to insurance B for the remaining 4. That feels a bit like double dipping since the 59426 is the high limit to include all prenatal visits. If it was reversed with insurance A with 4 visits and insurance B with 7 visits, I would likely bill only insurance B because the 59426 would cover all visits over the 7 (including the 4 under the previous insurance).

Thoughts, insight, experiences???

Thanks.