Wiki When does OB coverage begin?

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Deb2009

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Two scenarios:

1) Patient is seen by PCP and given a pregnancy test. She is then referred to OB. Do we start with 9920X or with the global package since we know she is pregnant when she comes to us? Medicaid is the real question here because each visit is billed and the first is an E/M and the second is 58425.

2) Our nurses do a H&P and then the provider sees the patient for their initial visit one week later. Again, what starts the global period? The nurse visit or the providier visit? 9920X and with Medicaid the E/M or the 59425?

If anyone has documentation or can point me to information I would appreciate it very much.
 
The pregnancy is confirmed, the global period begins when the flow sheet starts, and I am thinking that is on the first visit when your nurse does the H&P. Global care starts with the first visit. Confirmation of pregnancy can be billed, then the patient comes back in 2 weeks for sono/visit her global period begins.
 
Thank you,

We don't charge for the nurse visit because the physician hasn't seen the patient yet? So when he/she does see the patient is that an E/M visit with Medicaid or the 59425?

And then again, with transfer of care if the patient was seen 3 visits by another provider and then comes to our office. Medicaid insurance do I charge 1st visit as 992xx or 59425 (#4)

Thanks for any input.
 
Why would you charge 59425? That is for antepartum care if they have only had 4-6 visits? I don't know about your Medicaid, but usually you will bill every visit, or you will bill globally at delivery. Which is the correct process for your state?

Usually 59425 and 59426 are used for a break in insurance plans, when you need to bill BCBS for antepartum visits only....or if a change in provider you would bill that way.
 
If an OB patient transfers care from another practice you can not charge for the visit. You would have to bill at the end depending how many visits she has with you 4-6 59425 or
7+ 59426 and then you would bill delivery and postpartum. You can not bill the global 59400 or 59510.
 
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