Advanced Search

Ob-Gyn Coding Alert

Reader Question:

90385 or J2790: Query Payer for RhoGAM® Claim

Published on Mon Sep 05, 2011

Question: A patient came into our ob-gyn office just for a RhoGAM® shot and not for her return OB visit. A nurse provided the injection. The initial claim had 90384 and 96372 with V07.2. The insurance company denied it, saying it is not routine. Our office billed the patient for her deductible. Shouldn't this be part of global care? Is the coding incorrect? Georgia Subscriber Answer: RhoGAM® is not part of a patient's global care. Most payers pay separately for this. You don't specify whether you applied the injection procedure or the drug itself to her deductible (or both). That is a coverage issue between the patient and her insurance company and should have nothing to do with when it was given (separate visit or at the time of the return OB visit). You billed this encounter correctly assuming the program accepts the CPT® code for the drug (90384, Rho[D] [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Ob-Gyn Coding Alert

View All