Wiki Global OB Care - itemization

[sheria218@gmail.com]

Could other OB/GYN coders please let me know how they handle the following:
Global OB billing (59400 and 59510) both cover antepartum care, delivery and postpartum care. Would I would like to verify is when there is the need to break these codes down and itemize them. When a patient's insurance changes during her OB care, is global obstetrical billing eliminated all together? What I think is that I bill the first insurance for all services including antepartum care with appropriate E/M and antepartum care codes. Then when the second insurance begins, you MUST itemize that as well? Bill antepartum visits, delivery and post partum under that insurance? I have heard it suggested (from unnamed source) to not bill the first insurance at all, and to bill the second insurance GLOBALLY. Just wanna be sure I am understanding this correctly. Thanks - Sheri

 

[wschiller]

If there is any change in insurance or a transfer of care from one physician to another then global billing is no longer applicable. If you check the carriers websites some of them have specific instructions for antepartum billing. You have to evaluate the patient chart to see how many visits they had before and after the change. for 3 visits or less you bill individual visits. for 4-6 visits you bill 59425 or for 7+ visits you bill 59426. Then at delivery you bill delivery with post partum care only (if you are seeing the pt for pp). There are certain data elements that need to be on the claim - you should include a note that says why you are billing antepartum and the dates of service if you are billing 59425 or 59426.

With that said - it can be quite a pain because the carriers are not looking at the data sent in and will frequently deny the charges on first review. A quick phone call to tell them it is for antepartum charges usually gets the claim processed.

Hope this helps