Wiki Global Delivery

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tlperry0615

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Our office has a patient who transferred to our care at 22 weeks (having 5 visits with the previous OB). The patient ended up being high risk and needed more care than a normal pregnancy (over 20 visits before delivery, with a number of ultrasounds, injections ect) - we billed for a global delivery (59400), however Aetna will not remit payment to us due to the other OB billing 59425. With 2 attempts at appealing with supporting documentation to show Aetna that the patient had above the normal care and that we should be paid for this they do not seem to be budging on their decision, only telling us we need to change our delivery code due to bundling in their system with the 59425.

We are stuck on where to move next with this claim. Any input would be appreciated!
 
The insurance is unfortunately correct. But you can bill the 59426 (over 7 antepartum visits) and add a modifier 22 and increase the price. Then attach a letter and notes stating that she as high risk and needed to be seen 20 times.

For the delivery you will need to bill either the 59515 (c/s with postpartum care) or 59410 (SVD with postpartum care)
 
You will need to break down the visits into the 59426 and then bill out the delivery w/ postpartum care. You can add modifier -22 to the 59426 code, I believe, and of course the documentation to support the "increased procedural services". The -22 modifier may need to go on the delivery code, you may need to look further in to that. Hope this helps.
 
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