Forum - Questions & Answers

Feb 3rd, 2016 - bsrinivasarao777     3 

billable or inclusive

Hi, all I hope you all are doing well. I am new to OB coding …….

Here one of my OB provider had billed 99213 with O20.0 for a routine antepartum visit. This claim got denied as not payable and stated it will be inclusive within global service (59400 or 59510) .which is going to be billed in future.

Please I need your assistance on this weather it can be billable or inclusive.

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Feb 3rd, 2016 - LBAROGIANIS 250 

re: billable or inclusive

CPT® 59400: READS:
The physician delivers an infant and placenta through the uterus and vagina. The physician may elect to assist the delivery with the use of forceps, vacuum extraction, or rupture of membranes. The physician may also elect to do an episiotomy, which is an incision in the perineum to widen the external opening. Episiotomy and laceration repair are included as well. This procedure covers both antepartum and postpartum care. Antepartum or prenatal care includes the initial and subsequent histories, physical examinations, recording of weight, blood pressures, fetal heart tones, and routine chemical urinalysis. It includes monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery. Postpartum care includes hospital and office visits following delivery.

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Feb 3rd, 2016 - bjones2301 21 

re: billable or inclusive

The denial is correct in that you cannot bill each individual antepartum visit. It is all part of the global 59400 or 59510 unless the patient is seen for a condition unrelated to the pregnancy e.g. sinusitus, UTI. Also note that according the the ACOG Coding Manual/AMA "If a patient is seen for more than 13 antepartum visits due to a complication related to the pregnancy e.g. bleeding, gestational diabetes, report the visits seperately.
So what I do is when I go to bill global OB care I look at the number of antepartum visits, if there are more than 13 I review the record to see if this patient had complications in the pregnancy. If so I bill the extra visits.

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Feb 3rd, 2016 - bsrinivasarao777     3 

re: billable or inclusive

Thank you for your great help

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