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
different from the other medical specialties.
Maternity care services typically include
antepartum care, delivery services, and
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
dont end here the billing team has to deal with
patients with split OB-GYN billing. This blog
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.
Still, 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
  only deals with routine antepartum care.
• The maternal-fetal specialist usually 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.
• While this may seem like concurrent care, it 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 argue that
  the obstetrician should still bill 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 sees the specialist, that
  physician will bill the individual E/M visit
  (99202-99215), not antepartum care, and will
  report 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

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• (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.
• Switched Insurance Carriers Mid-Pregnancy
• You might encounter 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 and the delivery and
  postpartum care.
• The global obstetric code becomes obsolete when a
  patient changes insurance carriers in
  mid-pregnancy. 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

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• 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.
• In addition, you should report the appropriate
  code for delivery with postpartum care such as
  59410 (Vaginal delivery only with or without
  episiotomy and 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 and 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 with OB-GYN Billing and help
  you avoid duplicate billing in such scenarios. To
  learn more about our billing and coding services,
  email us at info_at_medicalbillersandcoders.com or
  call us at 888-357-3226.

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• FAQs
• What is split OB GYN billing?
• Split OB GYN billing refers to the process of
  dividing obstetric and gynecologic care into
  separate billing components. This can happen when
  different providers handle different parts of a
  patients care, such as prenatal visits,
  delivery, and postpartum care.
• 2. Why is it important to understand split
  billing in OB GYN?
• Understanding split billing is crucial to avoid
  duplicate billing and ensure accurate
  reimbursement. It helps healthcare providers
  correctly bill for each component of care without
  overcharging patients or insurance companies.
• 3. What are the common components of OB GYN care
  that might be billed separately?
• Common components of OB GYN care that might be
  billed separately include prenatal visits,
  laboratory tests, ultrasounds, delivery (vaginal
  or cesarean), and postpartum care. Each of these
  services may require individual billing codes.

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Understand Split OB GYN Billing to Avoid
Duplicate Billing

• 4. How can duplicate billing occur in OB GYN
  services?
• Duplicate billing can occur when the same service
  is billed more than once, either by the same
  provider or different providers. This often
  happens due to miscommunication, lack of
  coordination, or errors in the billing process.
• 5. What strategies can be used to prevent
  duplicate billing in OB GYN?
• Strategies to prevent duplicate billing include
• Ensuring clear communication and coordination
  among all providers involved in a patients care.
• Using accurate and detailed documentation.
• Regularly auditing billing practices to identify
  and correct errors.
• Implementing robust billing software that flags
  potential duplicate entries.