Patient A Had A Cbc And A Pft Performed. Which Type Of Insurance Will Cover The Services?
To bill "normal, uncomplicated" maternity care, written report a single CPT® code, based on the delivery:
- 59400 Routine obstetric intendance including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
- 59510 Routine obstetric care including antepartum care, cesarean commitment, and postpartum care
- 59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
- 59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum intendance, post-obit attempted vaginal delivery subsequently previous cesarean delivery
If the physician does non perform all services described by the global codes (for case, the patient receives irregular or late prenatal care, experiences a miscarriage or terminates a pregnancy, or changes providers during the pregnancy), you may study delivery, antepartum intendance, and postpartum care independently of 1 some other, using dedicated codes. CPT® motherhood care guidelines (and related CPT Assistant manufactures) give aplenty guidance to apply these maternity care codes correctly, in nigh situations.
The Switch
There's a mutual maternity intendance coding and billing scenario that CPT® guidelines do not accost: The patient switches insurance during the pregnancy, but keeps the aforementioned physician.
In such a example, proper billing volition depend on the payer. As a general dominion, each insurer will pay only for that verbal portion of care for which it is responsible. To illustrate, the following guidance is taken from the Health Reimbursement Policy of Moda Health, a private insurer in Alaska, Oregon, and Washington:
The patient presents to your clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly, and in her 21st week she has a change of insurer. She continues to be seen monthly for the remainder of her starting time 28 weeks, so biweekly to 36 weeks, so weekly until her delivery at 39 weeks for a total of xiii visits. The clinic performs the vaginal delivery and provides the postpartum care.
The billing role bills the first iv visits to carrier A with 59425 [Antepartum care only; 4-half dozen visits] using the date of the starting time visit as the From date and the date of their last visit before the change in insurance as the To date. The additional ix visits are billed to carrier B with 59426 [Antepartum intendance merely; 7 or more than visits]. This claim also bills the commitment and postpartum care with 59410 [Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum intendance]. The delivery engagement should be used as the date of service for all services on both claims.
There may be exceptions to this rule. For example, if the patient delivers late or has multiple "worried well" visits from the point she switched insurance, the requirements of insurance "B" might exist met, and global billing (e.g., 49400)—not itemized billing—may be warranted. This is a greyness area, so contact the responsible payer for instruction, prior to billing.
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Source: https://www.aapc.com/blog/34674-coding-and-billing-maternity-care-when-a-patient-changes-insurance/
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