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bonncruise

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I work in an FQHC and we are now getting denials from insurance companies who want us to submit one bill for the entire pregnancy. We have two providers one is a Doctor and the other is a nurse midwife. They sometimes see each others patients. We see our patients for ante-partum care and post-partum care only. Neither provider does any deliveries. I am trying to come up with a solution to just send one bill at the duration of the pregnancy but I cannot find any good examples on how to do this. If anyone can help, it would be greatly appreciated. Also, I need a good example of how to keep track of office visits. Would a dummy code be used each time the patient comes in to track the office visits?

Thanks,

Bonnie Bleacher, CPC
 
We are a Rural Health clinic and have 3 OBGYNs and a NP who see eachothers patients as needed. We have created a dummy code for our tracking purposes - GLOBAL, likewise we created a postpartum dummy code POSTPA for our commercial payers. This allows us to track the patients visits within our database and run reports if necessary to track provider revenue and still bill the correspoding CPT global or OB visit code to the commercial payer at the end of the patients care. For example if seen for 7 GLOBAL (antepartum) visits and delivered elsewhere we would bill 59426 under the "main" provider using the DOS for the patients last official antepartum visit with us. Our patients are set up under one physician as their primary OB care provider, however, they see the others as necessary.

Let me know if I can be of further assistance. We have been RH for our OBGYN clinic for 6 years now and have been utilizing the dummy codes even prior to that time simply for tracking and reporting purposes.
 
Thanks for your information. I was thinking something along those lines with dummy billing codes. Quick question. If a pt is seen here for all prenatal care including the intake would you bill the 99 codes for the first 3 visits then bill the 59425 for visits 4-6 and then 59426 for the 7+ visits?

Kind of look something like this
1/1/13 99211 Prenatal
1/14/13 99213 Inital exam with Provider
2/14/13 99212 belly check
then 59425 for visits 4-6
59426 for visits 7-?
and then finally 59430 for the post partum

or

Would you just do a 59426 with the closest visit to delivery and then a 59430 for the date of the post partum visit.

Just trying to wrap my head around this.

Thanks for your imput.
 
Why do you have a 99211 13 days prior to the initial exam with the provider? If this is a nurse visit you cannot do this, to bill a 99211 the provider must have seen the patient in a previous encounter and ordered a followup visit for the nurse. The RN cannot be the first provider to see a patient for a problem and then render the diagnosis. The provider must see the patient first for the suspected pregnancy and bill an OV with the V72.4- (do NOT use 626.0) dx code then the next visit starts the OB record. OR the OB sees the patient after the pregnancy has been confirmed by PCP then the first encounter is the OB record start with the V22.- code and any antenatal screenings.
 
As far as the dates go I was just using examples but we are an FQHC and I was told by my billing manager that we have to do an intake before the pt see's the provider. We usually have the pt see the provider within 2 weeks of the intake. For the intake the Pre-Natal nurse bills a v72.42 with a 99211 or 99201. Then once the pt see's the provider we use the approriate V22. code. Most times our pre-natal pt's have had a confirmed pregnancy dx with a provider prior to this encounter so perhaps my example was not a good example.

Thanks Debra for your response and help.
 
The majority of our OBs have already had their pregnancy confirmed, so their initial visit begins their OB record and therefore, is not separately billed. Our NP does an OB intake for all OB patients prior to their visit with the provider. This is an hour long visit in which she provides guidance and obtains all history information. This intake initializes the OB care since in most cases the pregnancy has already been confirmed. We created a dummy code for this as well INTAKE. Likewise, the first visit with the provider and a belly check are not billed with a separate E&M, as they are routine to the OB care and the pregnancy has already been confirmed. In your example we would bill:

59425 or 59426 using the last OB visit DOS
59430 on the day of postpartum visit

Again, this is for our commercial payers.
For Rural Health Medicaid MO we bill an E&M for each DOS (except nurse only visits- as a face to face with a physician is required and therefore, nurse only visits are not separately payable). A requirment by Rural Health is to staff and utilize NPs, billing services under their NPI. This being the case we bill an E&M for the initial NP intake and then an E&M for each additional visit by either the NP or Physician.

I'll be happy to provide my email address if you feel I can be of further assistance. I know your FQHC and I am Rural Health, but the two are quite similar. One thing to remember when dealing with either one, is that they do differ in some aspects from the traditional guidelines set forth for commercial payers.
 
Last edited:
AR2728 said:
The majority of our OBs have already had their pregnancy confirmed, so their initial visit begins their OB record and therefore, is not separately billed. Our NP does an OB intake for all OB patients prior to their visit with the provider. This is an hour long visit in which she provides guidance and obtains all history information. This intake initializes the OB care since in most cases the pregnancy has already been confirmed. We created a dummy code for this as well INTAKE. Likewise, the first visit with the provider and a belly check are not billed with a separate E&M, as they are routine to the OB care and the pregnancy has already been confirmed. In your example we would bill:

59425 or 59426 using the last OB visit DOS
59430 on the day of postpartum visit

Again, this is for our commercial payers.
For Rural Health Medicaid MO we bill an E&M for each DOS (except nurse only visits- as a face to face with a physician is required and therefore, nurse only visits are not separately payable). A requirment by Rural Health is to staff and utilize NPs, billing services under their NPI. This being the case we bill an E&M for the initial NP intake and then an E&M for each additional visit by either the NP or Physician.

I'll be happy to provide my email address if you feel I can be of further assistance. I know your FQHC and I am Rural Health, but the two are quite similar. One thing to remember when dealing with either one, is that they do differ in some aspects from the traditional guidelines set forth for commercial payers.
Click to expand...

AR2728-your quote about prenatal billing for FQHC, billin an E/M visit for each visit; where did you get this billing guideline?
 
Help inexpereinced ob-gyn coder here

Hi All,

I currently work at a FQHC and we are currently experiencing some issues with maternity global billing. I do not have ANY experience in OB-GYN billing or coding but was given this responsibility to me by my supervisor. I have a brief understanding how the package works but still lacks some knowledge in it. I would appreciate advice and some guidance regarding coding and billing for maternity global billing.

From my understanding, the DOS would be the delivery date. The first three would be the E/M visit, Antepartum and Postpartum.


I was wondering, do you bill for the pregnancy exam as the first E/M visit and do you send out one claim with all the visit at once? And are antibody, venipuncture and urinalysis bundled in the package?

Here is a breakdown,

7/6/2014 - 99215
9/11/2014 - 99213
10/10/2014 - 99213

10/15/2014 - 12/24/2014 - 59426 - Antepartum

1/2/2015 -59430 - Postpartum

Thank you all in advance.

CS
 
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