# Unrelated E/M in the maternity



## Partha (Apr 28, 2010)

Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?

Any inputs will be greatly appreciated.


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## Mjones7 (Apr 28, 2010)

Partha said:


> Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?
> 
> Any inputs will be greatly appreciated.



Hello:

I would bill the appropiate E/M with the unrelated to pregnacy dx and a modifier -24.  Best Wishes!


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## Lisa Bledsoe (Apr 28, 2010)

All carriers have their own policies on this issue.  UHC will pay if you use mod -25.  I believe Aetna considers everything as inclusive to the global.  I suggest checking the reimbursement policy for the patients insurance.  Good luck!


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## bonzaibex (Apr 28, 2010)

The unrelated dx & problem E&M code should be sufficient.  A 25 modifier might be needed if you use a V22.2 as your secondary dx..........Rebecca Hardin, CPC


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