Wiki Billing Antepartum Care with 3 or fewer visits

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cameron.moriarty

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I'm trying to bill for a delivery to an Arizona Medicaid provider administered by United HealthCare. I submitted 59400 for Vaginal Delivery with Antepartum care. To pay this Medicaid requires 59425 or 59426 however the Doctor only saw the Patient was only seen 3 times before delivery due to transfer of care and 59425 requires at least 4 visits.

Right now I'm looking at billing 59409 for Vaginal Delivery Only, but since that will obviously pay less I'm hoping someone with more experience has a suggestion for what I could do.

Thanks,

Cameron
 
When this happens at my office we bill the appropriate E/M level for those 3 visits (your dates of service will be the actual dates she was seen) and for the diagnosis we use V22.0 or V22.1 if its a normal pregnancy, if not use the appropriate pregnancy complication code.
These visits are usually very low levels (99212) since they are usually routine OB checks that do not require a lot of work.
Remeber that you cannot charge the first nurse visit (nurse intake) if your office does that, only the times she saw the provider.

For the delivery you would want to charge 59410 (Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care).
This is assuming she will be back for postpartum care.
If she is not then 59409 would be appropriate.
 
Antepartum visits

cameron.moriarty said:
I'm trying to bill for a delivery to an Arizona Medicaid provider administered by United HealthCare. I submitted 59400 for Vaginal Delivery with Antepartum care. To pay this Medicaid requires 59425 or 59426 however the Doctor only saw the Patient was only seen 3 times before delivery due to transfer of care and 59425 requires at least 4 visits.

Right now I'm looking at billing 59409 for Vaginal Delivery Only, but since that will obviously pay less I'm hoping someone with more experience has a suggestion for what I could do.

Thanks,

Cameron
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This is not a MEDICAID guideline this is the guideline for all insurances. If you have been billing 59400 and doing any less than 9 global antepartum visits (supported), this may be misconstrued as fraud w/o services. The 59400 does not get billed in addition to the antepartum 59425 or 59426. Any visits under 4 visits would simply be billed as an outpt E & M 99212-99215 with the proper DOS, depending upon documentation/complication using the ICD 9 V22.0 or V22.1 (unless there were complications then use the 600 series dx). If pt is coming to see your MD for the postpartum, I would use the 59410 and then bill out the antepartum separately. More $.
 
OB Care

Also, if they didn't have the same insurance during the entire pregnancy you always have to split the antepartum visit charges up based on the DOS and their eligibility periods. Just a heads up, as if they have applied for Medicaid based on a pregnancy, they often start out as straight DSHS and then get thrown on a managed care plan after 45-60 days.
 
Cardio coding help please

left lower extremity angio
angiojet thrombectomy on left popliteal artery
angiojet thrombo left posterior tibial artery
Angiojet thrombo left anterior tibial artery
Angiojet left peroneal artery
PTCA with stent to left posterior tibial artery
Balloon angio to peroneal artery and last but not least balloon angio of the left anterior tibial artery.

Can anyone with more cardio coding please advise?
 
Cardio coding help please

left lower extremity angio
angiojet thrombectomy on left popliteal artery
angiojet thrombo left posterior tibial artery
Angiojet thrombo left anterior tibial artery
Angiojet left peroneal artery
PTCA with stent to left posterior tibial artery
Balloon angio to peroneal artery and last but not least balloon angio of the left anterior tibial artery.

Can anyone with more cardio coding please advise?
:eek:
 
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