Wiki Complications of Pregnancy billing for ICD-9

[ollielooya]

Simple pregnancy related coding?
I have no experience whatsoever in pregnancy coding and am still a little unsure of myself even after reading the guidelines and other related material, so need help from my colleagues.

New Patient presented early June for office visit (99202) with absence of menstruation (626.0) and a pregnancy test (81025)
Bill was paid by commercial carrier.
11 days later she was seen again for threatened abortion (640.00) and hemorrhage in early pregnancy (649.50). This time the 99213 office visit was NOT paid due to global issues per the carrier.

Carrier said to provide the correct modifier, and/or supply chart notes. If a modifier is to be used for this one line item which one is appropriate?

Another question: Why do I not know this?

 

[Cmama12]

It's hard to say without seeing the notes.. 649.50 is spotting compl preg though. 640.00 is the threatened abortion code. I can't see any reason for them not paying. You wouldn't need a modifier unless a procedure was performed at one or the other of the appointments.. was there anything else?

 

[ollielooya]

Help on pregnancy coding; received chart notes

Again, those of you who are skilled in pregnancy billing are asked to look at this chart note for patient was was seen by her PCP physician. Carrier denied it for global concerns as indicated in my original post. Shall I go ahead and submit to commercial Aetna carrier with these chart notes, or send in a corrected claim using the proper modifier, and in this case wondering what that might be?


Date: xxxxx Time: xxxxx
Threaten ABORTION vs implantation bleeding

S. 28 YO woman presents these symptoms:
Estimated gestational age 6 wks and 5 days
Nausea: yes
Vomiting: yes
Breast tenderness: yes
Vaginal bleeding brown discharge yesterday evening-again today.
Dysmenorrheal

Obstetrical HX
Gravida: 1

Past Medical HX
Child
Birth weight
Type of delivery
Childhood immunizations up-to-date YES
Childhood problems NO
Rheumatic fever NO
High blood pressure NO
Ischemic Hearth disease NO
Thyroid problem NO
FEMALE
Gynecological HX:
Menarche
Pregnancy no x2
Delivery

Past Surgical HX: none

Hospitalizations:

Allergic History: all NKDA
Current medications: prenatal vitamins YES
Social HS: Marital status: married

O. General. Well appearing, well nourished in no distress. Oriented x3, normal mood and affect.
Heart: no cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop
Lungs? clear to auscultation and percussion
Abdomen? bowel sounds nl, no tenderness, organomegaly, masses, or hernia
Pelvic? EGBUS nl, vagina and cervix w/o lesions or discharge. Uterus and adnexa/paretria nontender without masses.

Quantitative Beta HCG ordered and pelvic limited ob u/s ordered

A:
Intrauterine pregnancy
Estamated gestation age: 6.5 weeks
Threaten ABORTION: vs implantation bleeding

P:
Laboratory? qunt hcg done today and repeat in 48 hrs
She has appoint with DR XXXXX on 23rd
PELVIC U/S ordered

Medication: Prenatal vitamin with folate

Patient education:
Avoid alcohol, tobacco, over the couter medications other than Aceteminophen.

Report called with normal u/s heart beat in normal intrauterine preg identified
Hcg reported consistent with her 6-7 weeks preg reports called and pt reassured recommend to get repeat quant hcg on Wednesday. Will give Zofran for nausea.