A payer wants our office to use the global obstetric code (59400) with the modifier-22 for a patient who switched insurance carriers mid-pregnancy so that another insurance company will be responsible for a portion of the bills. The company also wants us to attach a comment to the claim indicating how many times the patient was seen and the amount of reimbursement from the first insurance carrier. Is this proper?
No, the insurance company’s recommendations represent inappropriate coding practices. Conventionally, when a patient changes insurance companies mid-pregnancy, the global obstetric code becomes obsolete. Why? Billing for the antepartum visits must be divided between 2 different insurers. Instead, 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.