When we have a patient with an insurance change or transfers in or out of our office for maternity care, we have to then prorate her ob charges. If a patient is seen for under 4 office visits, you have to bill out an E&M code like 99213. In the past, we have always billed this with a note on the claim stating "Prorated due to insurance change in pregnancy" or "Prorated due to transfer of care in pregnancy". The insurance companies choose to either just process the claim or deny for needing more information. If this happens we call, explain the reason, and they reprocess the claim. Recently, we have received denials from Lifewise, UHC and Aetna stating we need to attach modifier "TH" to the claim for processing.
I have been billing for an OB/GYN office for 6 years and have never come accross this before. Can someone please tell me if they have heard of this before?
Thanks!
I have been billing for an OB/GYN office for 6 years and have never come accross this before. Can someone please tell me if they have heard of this before?
Thanks!