Wiki Medicaid OB Delivery Denials

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mandim

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I am new to coding Ob deliveries. I don't seem to be having issues with payors aside from Medicaid or managed Medicaid plans. Example below:
Vaginal Delivery with complications as diagnosed. What am I missing? They are either stating Medical Necessity has not been met or a supportive dx needs to be added. Any help is appreciated!
59409
O76
O99.214
O99.284
O99.334
O72.2
E03.9
Z37.0
Z3A.40
 
On Medicaid's website, they have a list of covered codes for deliveries. Have you looked on there? They had to direct me how to access it. If you call them, they can lead you right to it. Dumb question, but I am assuming you're only trying to bill for the vag delivery, not the global package or the post partum care? If that's the case, your CPT code is correct. You'll need to append a 22 modifier and upload the op report. I recall billing O76 as a primary code to Medicaid as well at one point thinking that should cover it and they kept denying it. (I was completely confused) Once I looked at their list of covered codes, I was able to find something that fit the patient and I was finally able to get paid.
I'd remove the E03.9 because you basically already have the O99.284
I personally always list Z37.0 as my last code. Just my preference
 
Does the carrier require modifiers U7, U8, U9, UB? In my state, Medicaid and most of the managed Medicaid want those modifiers.
Unless your ICD10s are hitting against a guideline or excludes note, that's where I would check ESPECIALLY if it's only your Medicaid & managed Medicaid.
 
I have scoured Medicaids website so many times looking for this information. It should be easier! Ugh. Thank you! I will call and get guidance. Yes, I am only billing the vag delivery. Thanks again for your help!
 
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