GLOBAL MATERNITY BILLING TIPS- A SIX PART SERIES

PART 1- BLUE CROSS BLUE SHIELD OF NC

Global maternity care includes pregnancy-related antepartum care (4 or more), admission to labor and delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care. Typically, a global charge should be billed for maternity claims when all maternity-related services are provided by the same physician.
SPLIT BILLING FOR BCBS

There are several circumstances that may require you to bill delivery, antepartum, and postpartum separate:

  • If the member’s coverage started after the onset of pregnancy.
  • If the coverage terminates prior to delivery.
  • If the pregnancy does not result in delivery.
  • If another provider in a different practice assumes care of the member prior to completion of global services.
  • If during the member’s pregnancy, there was a change in the member’s benefit package or certificate number due to an employer change only.

Antepartum services below are not considered a part of global maternity services and should be billed separately as services are rendered.

  • Diagnostic ultrasound
  • Amniocentesis
  • Cordocentesis
  • Fetal stress test/NST​
THINGS TO REMEMBER:
  • An initial visit (confirming the pregnancy) is not apart of global maternity care services.
  • A global charge should be billed when one or more physicians, practicing at the same location, provide all components of the patient’s maternity care.
  • The number of antepartum visits may vary with each patient.

Services unrelated to pregnancy, performed by the physician rendering global maternity care, should be documented and reported separately. The primary diagnosis code should be a condition unrelated to pregnancy.

PART 2- UNITED HEALTHCARE

Global maternity care for UnitedHealthcare is referred to as “Obstetrical Services Policy”.  This includes prenatal visits (up to 3 in addition to the global package), admission to labor and delivery, management of labor including fetal monitoring, delivery, cerclage removal, and uncomplicated postpartum care.

SPLIT BILLING FOR UHC
There are several circumstances that may require you to bill delivery, antepartum, and postpartum separate:

  • If the member transfers into or out of a physician or group practice
  • If the member is referred to another physician during her pregnancy
  • If the pregnancy does not result in delivery.
  • If another provider in a different practice assumes care of the member prior to completion of global services.
  • If the member changes insurers during pregnancy
THINGS TO REMEMBER:
  • When billing for antepartum care only utilizing 59425 or 59426, count all visits the patient was seen for by the rendering provider.
  • Choose the appropriate code, bill as “1” unit with a date span.
  • The beginning date should be the first OB visit, the end date of your claim should be the last OB visit.

PART 3- NC MEDICAID

Global maternity care for NC Medicaid includes postpartum care, labor and delivery when antepartum care was initiated at least three months before the delivery and the same provider performs the delivery and postpartum care.

SPLIT BILLING FOR NC MEDICAID
There are several circumstances that may require you to bill delivery, antepartum, and postpartum separate:

  • If the member is seen for less than three months
  • If the member changes insurers during pregnancy
  • If another provider in a different practice assumes care of the member prior to completion of global services.
  • If the pregnancy does not result in delivery.
  • If the coverage terminates prior to delivery.

THINGS TO REMEMBER:

  • When billing for multiple births, you are required to use modifiers -51, -59.
  • When a  patient is seen by the provider between 1 and  3 visits, the visits should be coded as an E/M service, according to the services that were provided.

PART 4- CIGNA

Cigna_global_maternity_obstetric_package

Global maternity care for Cigna is referred to as the “total obstetric package”, and includes antepartum care,  delivery, and postpartum care. ​

SPLIT BILLING FOR CIGNA
There are several circumstances that may require you to bill delivery, antepartum, and postpartum separate:

  • If the member is seen only for the first one to three antepartum visits.
  • If another provider in a different practice assumes care of the member prior to completion of global services.
  • If the pregnancy does not result in delivery.
  • If the member is seen for delivery only/postpartum care only or both.
THINGS TO REMEMBER:
  • Complications of pregnancy are not considered routine obstetric care and are not included in Global Maternity/Obstetric Package.  Documentation must be sent along with filing of claim to avoid denials.
  • If the delivering provider saw the patient for less than 3 antepartum visits, you will utilize the (Antepartum & Postpartum) codes above and bill the antepartum visits separate as E/M codes. Choose the appropriate code, bill as “1” unit with date of delivery as the date of service

PART 5- ​WHEN & HOW TO SPLIT BILL FOR GLOBAL MATERNITY

Utilize Split Billing When…

  • The patient has a change of insurer during her pregnancy. ​(Change in policy/terminations)
  • The patient has received part of her antenatal care somewhere else.
  • The pregnancy does not result in delivery.
  • The patient transfers her care to another provider.

TEST YOUR KNOWLEDGE

MEDICAL BILLING TIP:

  • Most commercial insurances want a date span on the claim when billing antepartum codes. This means if you bill a 59425 or 59426 your beginning date should be the first date of antepartum care and the ending date should be the last date of care. Be sure to submit your OB flowsheet with the claim to avoid any delay in payment.
  • NC Medicaid does NOT want a date span when billing antepartum codes. This means if you bill a 59425 or 59426 your beginning date should be the last date of antepartum care and your ending date will be the same. But you must enter the first date of antepartum care in the “same or similar illness date” (BOX  14 ON CMS1500).

Wrapping Up this Series!

Aetna Women’s Health Manual

SPLIT BILLING FOR AETNA

Physicians who provide some but not all prenatal care and delivery should bill for the portion of prenatal care according to the following CPT instructions:

  • 59425: 4-6 prenatal visits
  • 59426: 7+ visits
  • Use standard E&M codes for fewer than four prenatal visits
  • 59409: vaginal delivery only
  • 59410: vaginal delivery and postpartum care
  • 59514: cesarean delivery only
  • 59515: cesarean delivery and postpartum care
  • 59614: vaginal birth after cesarean delivery and postpartum care
  • 59612: vaginal birth after cesarean delivery only

High-risk Pregnancy Management Enhancement

Aetna pays an additional fee to the obstetric care provider for managing a high-risk pregnancy.

This applies to all products when the following are true:

  • The member is enrolled in the Beginning Right maternity program, if available.
  • Risk factors are identified.
  • There’s an increase in the intensity and/or frequency of care throughout the pregnancy.
  • Modifier 22 is added to the global obstetric fee claim

THINGS TO REMEMBER:

  • You will be reimbursed in addition to the global obstetric fee, when visiting an Aetna member during an antepartum inpatient stay.
  • Lab studies (CPT 85013, 85018, 82947, 82948, 82962) performed in the OB office will be reimbursed outside of the global obstetric fee.

 

 

For more on Medical Billing & Coding, Healthcare Administration, and Insurance News and Updates, you’re already at the right place. Be sure to stay on top of everything by subscribing to the Rx for Success Medical Billing Blog here!

Resources & Credits:
“Any trademarks, logos, or links (sources) used throughout this blog are the property of their respective owners.”

Blue Cross Blue Shield

United Health Group

NC Medicaid

Cigna

%d bloggers like this: