TESSA2019
Guest
QUESTION #1: Am I billing this correctly??
An Ob patient had Uhc ins (term date 09/25/2020) and was seen on the following dos:
05/20/20
06/19/20
07/17/20
08/14/20
bill cpt code 59425 to Uhc with beginning dos 05/20/2020 thru dos 08/14/20.
then her ins changed to Bcbs (effective date 09/25/2020) and she was seen on the following dos:
09/25/20
10/09/20
10/23/20
11/06/20
11/13/20
11/20/20
11/24/20
delivered Vbac on 11/28/20
bill cpt code 59610 to Bcbs with dos 11/28/20
QUESTION #2: Why are some being paid and some being paid and some being denied with the same dx codes?? AND... is this pt responsibility??
cpt code 76811 (ultrasound) was billed to ins with the following dx codes: "SOME" of them were denied not medically necessary and the balance was turned to the patient as patient responsibility (** BELOW **) and then some were paid by ins with the same dx codes: IM SO CONFUSED!!
CPT code 76811 w/dx codes: Z3482 & Z3A21
CPT code 76811 w/dx codes: O26842 & Z3A18
CPT code 76811 w/dx codes: Z3402 & Z3A18
** Its my understanding that when ins denies as not medically necessary that it is a coding issue (dx code is not supporting the cpt code or you have used the wrong cpt code ) and needs to be corrected and refiled.
**It is also my understanding that you can not bill the patient when something is denied by ins as not medically necessary. The eobs do not list the balance as the patients responsibility
QUESTION #3
An Ob pt transfers into our practice at 25 wks and we take over care for the remainder of the pregnancy, which includes the rest of the antepartum (7 or 8 visits) , delivery and postpartum. Do we bill the cpt global delivery code ?
An Ob patient had Uhc ins (term date 09/25/2020) and was seen on the following dos:
05/20/20
06/19/20
07/17/20
08/14/20
bill cpt code 59425 to Uhc with beginning dos 05/20/2020 thru dos 08/14/20.
then her ins changed to Bcbs (effective date 09/25/2020) and she was seen on the following dos:
09/25/20
10/09/20
10/23/20
11/06/20
11/13/20
11/20/20
11/24/20
delivered Vbac on 11/28/20
bill cpt code 59610 to Bcbs with dos 11/28/20
QUESTION #2: Why are some being paid and some being paid and some being denied with the same dx codes?? AND... is this pt responsibility??
cpt code 76811 (ultrasound) was billed to ins with the following dx codes: "SOME" of them were denied not medically necessary and the balance was turned to the patient as patient responsibility (** BELOW **) and then some were paid by ins with the same dx codes: IM SO CONFUSED!!
CPT code 76811 w/dx codes: Z3482 & Z3A21
CPT code 76811 w/dx codes: O26842 & Z3A18
CPT code 76811 w/dx codes: Z3402 & Z3A18
** Its my understanding that when ins denies as not medically necessary that it is a coding issue (dx code is not supporting the cpt code or you have used the wrong cpt code ) and needs to be corrected and refiled.
**It is also my understanding that you can not bill the patient when something is denied by ins as not medically necessary. The eobs do not list the balance as the patients responsibility
QUESTION #3
An Ob pt transfers into our practice at 25 wks and we take over care for the remainder of the pregnancy, which includes the rest of the antepartum (7 or 8 visits) , delivery and postpartum. Do we bill the cpt global delivery code ?
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