Thank you so very much for taking so much time with me. Our largest payor (BC) is denying E/M levels for visits 1-3 because they think it's bundled, right? Tons of billers are dealing with the same issue. I guess my question is if we can bill the original level 3 E/M for confirmation like we always do bc it's not part of the global and then "suspend" 0500F for initial OB plus the next two 0502F OB visits for this payor only until patient either 1) returns for 4th 0502F so that we can bill the visits globally or they transfer care/change insurance/pregnancy ends/, etc. and we can go back to the beginning and bill the first 3 visits as appropriate E/Ms instead of trying to un-bundle them from the global package by never placing them in it to begin with? I feel like I can't get what I'm thinking from my brain into words. If you've hung around long enough, thanks for trying to listen and understand.
If you see the patient for confirmation, then 1-3 antepartum only (transfers care, TOP, insurance change, etc), I would not bill the 1-3 E&M visits until delivery or the pregnancy ends. Same if >3 using either 59425 or 59426.
You should not be billing those first 3 visits as E&M as they occur, unless the payor does not accept global maternity and has instructed to bill individually as they occur. It seems like maybe that is what you are doing, and the carrier is then correct in denying them.
In our system, we enter the 050#F codes as they occur. Those are not submitted to insurance. We keep a spreadsheet of EDD dates to ensure we don't miss anything. If we are 2 weeks past the EDD and realize the patient needs split bill (transfer, delivered out of state when traveling, TOP, etc), we correct the 050#F codes to E&M or 59425 or 59426 and submit to insurance.
As care is being provided, we always go under the assumption that the practice will be providing antepartum, delivery, and postpartum care. If for some reason we do not, THEN we split bill. Keep in mind many split bill claims (even if appropriately coded) will require further documentation to payor to explain what/why/how it was split.
If this does not better explain for you, then please try to elaborate your specific situation.