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Wiki Coding 0502F

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rysanovka@gmail.com

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Hello,
Please help me with the following:
What are the coding requirements for 0502F?
What is purpose for using it?
Will the billing for 0502F code interfere with getting paid for global delivery codes such as 59400 and 59510?
Thank you.
 
What do you mean by billing? Often it is simply a tracking code for prenatals, and does not get billed out. However, some payers may want it used... previously in IL, the state Medicaid wanted to be be billed for each prenatal visit as they occurred and they wanted it billed with 0502F (now changed to e&m). Therefore, there was a fee attached for Medicaid providers in that state. The global obviously wouldn't be billed in that case. I don't know how common the second scenario is though.
 
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Thank you for your response.
What I meant is provider billed to Medicaid HMO 0502F (no E&M code) each time patient visited him.
Then, provider billed 59510, could Medicaid HMO denied the claim?
Thank you.
 
rysanovka@gmail.com said:
Thank you for your response.
What I meant is provider billed to Medicaid HMO 0502F (no E&M code) each time patient visited him.
Then, provider billed 59510, could Medicaid HMO denied the claim?
Thank you.
Click to expand...
Check their policy. It may be that they want the delivery only code billed, with postpartum care being either 0503F/59430
 
rysanovka@gmail.com said:
Thank you for your response.
What I meant is provider billed to Medicaid HMO 0502F (no E&M code) each time patient visited him.
Then, provider billed 59510, could Medicaid HMO denied the claim?
Thank you.
Click to expand...
Yes, they could because you have already been paid for the visits. Check with their policy manual for confirmation or their rep to avoid denials.
 
Hey there,
I want to ensure I'm understanding this correctly,

0500F -initial prenatal visit- bill on initial prenatal visit (1 unit)
0502F- sub. prenatal visit- bill on each prenatal visit (1 unit)
0503F-postpartum visit-bill on pp visit (1 unit)

When patient delivers, bill applicable global obstetric care cpt (59400/59510/59610)


(NY-managed Medicaid plans)
 
klapetri@ilovemygyn.com said:
Hey there,
I want to ensure I'm understanding this correctly,

0500F -initial prenatal visit- bill on initial prenatal visit (1 unit)
0502F- sub. prenatal visit- bill on each prenatal visit (1 unit)
0503F-postpartum visit-bill on pp visit (1 unit)

When patient delivers, bill applicable global obstetric care cpt (59400/59510/59610)


(NY-managed Medicaid plans)
Click to expand...
Currently NY Medicaid wants 0500F, 0502F, 0503F billed for EACH office visit that is part of global maternity. Most of the managed Medicaids either already also have this policy, or are about to implement.
Example - pt has 12 antepartum, vaginal delivery, and 1 postpartum.
05/22/2024 0500F
06/24/2024 0502F
07/24/2024 0502F
08/18/2024 0505F
09/19/2024 0502F
10/14/2024 0502F
11/06/2024 0502F
11/27/2024 0502F
12/04/2024 0502F
12/11/2024 0502F
12/18/2024 0502F
12/25/2024 0502F
12/30/2024 SPONTANEOUS LABOR & VAGINAL DELIVERY BILL GLOBAL 59400
01/14/2025 0503F

Any practice I've spoken with was already entering all these 0500F, 0502F, 0503F codes in their system anyway to match/close out appointments and encounters. The change is that now you need to actually submit those to insurance.
 
klapetri@ilovemygyn.com said:
HI,
okay great that's what I thought. When reviewing Healthfirst policy (PO-RE-132v1), the example listed seems cat 2 codes are to be billed on the same claim as delivery.
Click to expand...
HealthFirst does seem to hint at that on the example, but I don't see that it is required when reading the policy. In fact, it would be pretty impossible to submit all the services on the same claim for a variety of logistics reasons.
1) The POS for the 0500F, 0502F, 0503F would not be the same as for the delivery.
2) They also state in the paragraph above that example to assign the appropriate Z codes for the 0500F, 0502F, 0503F. If you are doing so with Z34.9__ AND Z3A.____ for week of gestation, you would have too many diagnoses to submit on one claim.
3) Each visit will be coded (and therefore submitted) soon after the visit, and each would be linked to a different encounter.
4) You could have multiple providers. Any EHR system I used automatically splits claims with different providers.
They way they provided the example with date range and units I don't think is feasible for the reasons above (and probably others I'm not even realizing).
I guess we'll find out when the policy starts in October 2025 if they don't update by then.
 
csperoni said:
HealthFirst does seem to hint at that on the example, but I don't see that it is required when reading the policy. In fact, it would be pretty impossible to submit all the services on the same claim for a variety of logistics reasons.
1) The POS for the 0500F, 0502F, 0503F would not be the same as for the delivery.
2) They also state in the paragraph above that example to assign the appropriate Z codes for the 0500F, 0502F, 0503F. If you are doing so with Z34.9__ AND Z3A.____ for week of gestation, you would have too many diagnoses to submit on one claim.
3) Each visit will be coded (and therefore submitted) soon after the visit, and each would be linked to a different encounter.
4) You could have multiple providers. Any EHR system I used automatically splits claims with different providers.
They way they provided the example with date range and units I don't think is feasible for the reasons above (and probably others I'm not even realizing).
I guess we'll find out when the policy starts in October 2025 if they don't update by then.
Click to expand...
understood. Also they have a provider alert no policy number. "Changes to Claims Submissions for Prenatal and Postpartum Services"
 
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