OOPS - i forgot to mention a very important part of the whole picture - these are OB patients - - - - - that makes a HUGE difference.......sorry! New OB patient - transferring in care after being seen out of state for antepartum care until now..
Thanks!
Well, I'm not an expert in OB - but here's my stab at it:
The out of state doc should be billing for their portion of the antepartum care only.
You also, will bill the antepartum care, but if your doc is assuming the total care (antepartum, delivery, postpartum care) you would only bill the global code depending on the type of delivery. (Of course you would also bill for the services unbundled in the global)
You would have to coordinate w/ the other doctor's billing staff to see how many visits she was seen for. I'm sure she has her complete medical records from the other doc, and that could give you your answer. Here's why: the insurance company will carve out the reimbursement from your global code for the antepartum codes the other doctor billed and got paid for already. Meaning the other doctor has performed a 'partial service' of the 'global service' you are billing for. Basically, you will receive less reimbursement for what the other doc got paid for.
If she only had 1-3 visits they should bill seperately codes 99201-99499 for those 1-3 visits. (Which isn't included in your global codes
)
If she had 4-6 visits - they bill 59425
If she had 7+ visits - they bill 59426
Now, assuming your patient has never seen any of your docs ever <which I hate to assume, but given shes out of state, I'll roll with it
) she technically IS a new patient - however, you shouldn't bill the 99201 - 99205 unless you are providing 3 antepartum visits or less, you would bill the total global package as described above.