Medical Billing – Don’t Be Tricked By Transfer Care

Medical Billing – Don’t Be Tricked By Transfer Care

Performing medical billing for maternity transfer of care can get sticky. There are certain rules you should follow to get correct reimbursement for your patients’ prenatal care. Their is a correct way to do medical billing for transfer of care.

There are two main ways to do medical billing for maternity care: separate visit reports, global billing. Separate medical billing means that you bill the prenatal visits separate from the delivery fee. Global fee means that you lump the prenatal visits and the delivery all into one large fee.

If a pregnant woman is transferred to your practice and you do maternity medical billing separately then you would use codes 59425 or 59426 for the visits. Each one of those codes assumes that you do a new patient evaluation regardless if the patient is established or not. The fee is built into the medical billing CPT codes. However, you would not do a complete evaluation and management for this patient if they were seen by another physician for pregnancy. Obstetrical care is just assumed by your physician.

If your physician uses a global fee for medical billing you again would use the first visit as a new patient visit, but would not do medical billing for an E/M if the patient is pregnant clearly. This is because you are not diagnosing pregnancy if she was already seen by another doctor for the condition.

All of this medical billing information can be thrown out the window when dealing with Medicaid. Many times Medicaid requests an evaluation and management code to be itemized. The bottom line: follow payers specific documentation requests for reimbursement. If every payer had the same rules, medical billing would be a snap. Unfortunately this is not the case. Just follow general medical billing guidelines and payers will let you know their preferences.

View all Articles by: Melissa Clark, CCS-P