Get Correct Reimbursement for Care of Multiple Fetuses
Published on Wed Mar 01, 2000
The good news is your patients in vitro fertilization was a success, shes pregnant! The challenging news is that shes pregnant with triplets. Her pregnancy presents numerous complications from a health, billing and reimbursement standpoint. To treat her potential complications properly and ensure the maximum reimbursement, take steps to avoid the hassles that lie down the road with regard to making a case for additional reimbursement.
Like many pregnancies with complications, the first step is to determine what evaluation and management (E/M) care is included in the global ob package, and what is considered above and beyond and therefore billable as separate from global. Each insurance provider generally establishes a certain number of visits that are considered part of the global package, usually around 12 or 13. Additional antepartum visits beyond 13, when backed up with the proper documentation, should be billable outside of the global ob fee.
More Babies Mean More Complicating Factors
Philip Eskew, MD, medical director of the women and childrens services at St. Vincent Hospital in Indianapolis, outlines some of the complications with grand multiparity. Any multiple pregnancy, says Eskew, is automatically considered a high-risk pregnancy. There are several more prenatal visits and a great deal more monitoring of the pregnancy that has to take place. Not only are you paying special attention to the mothers health but to the growth rate and health of all the babies. Typically, that extra care can involve such procedures as fetal non-stress tests (NSTs) (59025, fetal non-stress test), biophysical profiles (76818, fetal biophysical profile), and several ultrasounds to monitor the growth of each baby. Eskew also says that with multiparities, the blood pressure levels of both mother and fetuses require extra monitoring.
The main thing to remember with multiple gestations, says Eskew, is the numerous times that you have to see the patient. There are so many factors to considerand thats true even with a twin pregnancywhen you start talking about three or four babies, the workload increases exponentially.
Diana Barnes, a coder for Laurel Ob/Gyn Associates, a multi-physician practice in Charlotte, N.C., recalls a case of triplets delivered recently. We only saw the patient 15 times, says Barnes, which really isnt that far outside of the number of visits allowable in global. But we performed four ultrasounds, which is a little unusual, but she had some bleeding early on. Barnes continues, Her records also indicate that we did several injections of Celestone Soluspan (an intramuscular [IM] injection, HCPCS code J0702 or J0704) to prevent respiratory problems in the fetuses. We billed all of these items separately from the global care.
When conducting ultrasounds on more than one fetus, remember that you also are dealing with more than [...]
