Understand Split OB GYN Billing to Avoid Duplicate Billing

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Understand Split OB GYN Billing to Avoid
Duplicate Billing
Challenges of OB GYN Billing Coding and billing
for maternity obstetrical care are quite a bit
different from the rest of the medical
specialties. Maternity care services typically
include antepartum care, delivery services, as
well as postpartum care. Depending on the
patients circumstances and insurance carrier,
the provider can either, submit all rendered
services for the entire nine months of services
on one CMS-1500 claim form or submit claims based
on an itemization of maternity care service. The
challenges of maternity obstetrical care billing
doesnt end here, billing team has to deal to
patients where split OB GYN billing is involved.
In this article, we considered two billing
scenarios where split OB GYN billing is required
to avoid duplicate billing. Multiple Providers
Render Maternity Care Assume a scenario where
multiple providers render portions of maternity
care for the same patient. In such scenarios, one
physician treats the patient at the beginning of
her OB care, but as she develops complications
and is referred to a specialist for the remainder
of her care, you need to split billing to avoid
duplicate billing.
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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• While billing in such scenarios check whether the
  obstetrician and the specialist are seeing the
  patient for the same condition, which would be
  concurrent care. Or the specialist is dealing
  only with the complication while the obstetrician
  is dealing only with routine antepartum care.
• In most cases, the maternal-fetal specialist sees
  her once or twice for the complication and sends
  her back to the obstetrician for the rest of the
  care. Later in the pregnancy, another
  complication arises, and she goes back to the
  maternal-fetal specialist.
• And while this may seem like concurrent care, it
  really is not because the physicians are
  different, the diagnosis codes being used are
  different, and the regular obstetrician will bill
  for the routine antepartum services only. This
  means that they are not duplicating services.
• If this is the situation, you could make a case
  for the obstetrician still billing the global
  obstetric package if he goes on to deliver the
  baby and take care of the patient in the
  postpartum period because he is providing routine
  antepartum care.
• When the patient goes to see the specialist, that
  physician will bill the individual E/M visit
  (99202-99215), not antepartum care, and will be
  reporting the complication as the diagnosis.
  Alternatively, you could make a case for
  splitting the global package and having the
  obstetrician just bill for the antepartum care
  alone using 59425 (Antepartum care only 4-6
  visits) or 59426 (Antepartum care only 7 or more
  visits) if he transfers care to the specialist
  for the rest of the pregnancy.

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• Switched Insurance Carriers Mid-Pregnancy
• You might came across a scenario where an
  obstetric patient changes her insurance carrier
  mid-pregnancy. Lets say an obstetric patient
  attended 11 visits and then she changed her
  insurance carrier, she is still antepartum with
  possibly 15 more visits to go. This is a split OB
  GYN billing scenario where you have to split the
  bill among two payers along with the delivery and
  postpartum care.
• When a patient changes insurance carriers in
  mid-pregnancy, the global obstetric code becomes
  obsolete. You have to use the code 59425 (4 to 6
  antepartum visits) or code 59427 (7 antepartum
  visits) to bill each carrier separately and then
  bill the current payer for the delivery and
  post-partum care using the code 59410, if it is
  an uncomplicated vaginal delivery.
• In the above split OB GYN billing scenario where
  an obstetric patient attended 11 visits and then
  she changed her insurance carrier, you should
  bill 59426 (Antepartum care only 7 or more
  visits) to the first insurance company and 59425
  (Antepartum care only 4-6 visits) to the second
  if four to six visits are its responsibility. If,
  by the time she delivers, your OB GYN sees her
  only three times under the second insurer, you
  should report the appropriate established patient
  E/M service code (for example, 99212) for each
  visit instead of using 59425.

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• In addition, you should report the appropriate
  code for delivery with postpartum care such as
  59410 (Vaginal delivery only with or without
  episiotomy and/or forceps including postpartum
  care) to the second payer.
• In case of any confusion, always talk to
  insurance carriers and get their requests in
  writing. Inform the insurance plans medical
  director about the recommendations, also the
  implications for incorrect coding.
• We shared information on split OB GYN billing for
  provider education, you can always refer to
  billing guidelines or talk to an insurance rep
  for detailed guidance. Medical Billers and Coders
  (MBC) is a leading medical billing company
  providing complete medical billing and coding
  services.
• We can assist you in OB GYN billing and help you
  avoid any duplicate billing in such billing
  scenarios. To know more about our billing and
  coding services, email us at info_at_medicalbillersa
  ndcoders.com or call us at 888-357-3226.
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