Wiki split billing question

[jebond123]

I am reaching out for advice on my claims for a patient who started with our OB practice at 34 weeks She had 5 visits and then we delivered. I submitted 59425 & 59410. The claim for 59425 was denied due to another doctor billing antepartum care during same pregnancy. I have always billed this scenario in this way and never received this type of denial before. Wouldn't the dates of service clear up duplicate submissions by different doctors? The Aetna rep I spoke with had no explanation except to advise that I could try to bill each visit individually. I would appreciate any input on this. Specifically, am I wrong in my assumption about antepartum billing? Should I have used a modifier? Of note, the delivery processed with no problems. Thanks to all for any help.

 

[csperoni]

It sounds to me like you coded this correctly. Perhaps the original OB did not file their portion properly leading to your denial. I would not bill each visit individually UNLESS you find an Aetna policy stating to do so or that rep is willing to provide that guidance in writing. Absent that, I would appeal your claim referencing their own manual stating how you billed is correct. https://www.aetna.com/content/dam/a...nals/documents-forms/womens-health-manual.pdf. Specifically:
Physicians who provide some but not all of the prenatal care and delivery should bill for the portion of prenatal care according to the following CPT instructions:
• 59425: four to six prenatal visits
• 59426: seven or more visits
• Use standard E&M codes for fewer than four prenatal visits

 

[jebond123]

Thanks, Aetna finally reprocessed correctly for payment.