OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

California:
I have a question our providers merged with another company. They will bill out all future visit under another Tax ID> we have prenatal (antepartum) visits to bill under old Tax ID.

Delivery will be done by the same Dr's but different Tax ID. This is split billing.
Can we bill each visit , if it's more than 3 visits vs the OB Split Billing with the CPT® 59425 (3-6) or 59426 (7 or more). Is it something that written that states we can't bill out each code under the E/M.

I think I did let 1 or 2 go out that were more than 3 visits I wlll monitor to see if they were paid. I am new to OB billing. I have read the articles but it's not clear that it's mandatory to use 59425 or 59426.

Thanks for your help.

re: OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

According to cpt- you should use 59425 for 4-6 visits. Most major carriers expect this coding instead of 4-6 separate visits.

If you bill individual visits (even with 1-3 visits), most insurance companies will deny at first for "gobal billing" and you have to call and explain why it was billed (either pt transfer or miscarry,etc). Avoid the headache and bill with the antepartum codes.

re: OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

It been awhile since I have billed OB but, I am unsure if you should be billing antepartum at all the provider of service is not changing only your tax ID number.

Below is CPT® Assistant guidance in regards to antepartum billing:

Antepartum Care Visits (59425, 59426)

Code 59425, Antepartum care only; 4-6 visits, is reported when four to six antepartum care visits are provided. If the total antepartum care visits exceed six then code 59426, Antepartum care only; 7 or more visits, should be reported instead. Please note that each code is reported only once. When filling the units box on the claim form, indicate that "1" unit of service was provided when reporting codes 59425 or 59426. In the instance where the physician provides one, two, or three antepartum visits, then report each visit using the appropriate evaluation and management code (99201-99215).

Examples of Reporting Antepartum Care Services

Relocation of a patient. A patient is being treated by physician A. The patient then relocates to a different state and begins seeing physician B. Physician A provided four antepartum visits, and physician B provided eight antepartum visits, as well as performed the delivery and postpartum care. In this case, physician A would report code 59425 and physician B would report codes 59426 and 59410 for the delivery and postpartum care.

Termination of pregnancy. If a patient is being treated by a physician for three antepartum visits, and then experiences a miscarriage, each visit is reported with the appropriate evaluation and management code, as the entire global maternity care was not provided. Do not report code 59425 in this instance since only three antepartum visits were provided by the physician.

re: OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

You may want to read this thread as well : http://www.supercoder.com/my-ask-an-expert/topic/billing-antepartum-care-when-the-dr-changes-practices

re: OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

i have a question here:
what if the pt is seen by different physicians (around 3) in a clinic for antepartum OVs. It's been confusing on taking appropriate codes..

Should we bill like E/M for 1-3 visits, 59425 for 4-6 visits and 59426 for 7 & more vistis for each physician separately?
If not, what would be your suggestion.

Thanks in advance

re: OB Split Billing question use of E/M for more than 3 visit or 59425 (3-6) or 59426 (7 or more)

You cannot bill three antepartum care codes. The codes are based on number of visits, not different MD(s). The physicians need to come to an agreement (i.e., bill under the provider at the last visit). Then, if they are paid on production, you would split the reimbursement among them.