Wiki Medicaid PP visits

[poekar]

When you bill a medicaid c-sect delivery only code (59514) - we bill out all the pp only visits - even though we know we will only be reimbursed for 2 visits.

When the pt comes into the office for a stitch check - do you bill out the 59430 for this visit?

 

[AlaynaB]

I am not sure why you would bill out individually for the PP visits, when you know you will be performing all the PP care...? Why not report 59515? Your Medicaid reimbursement is likely higher and that the more appropriate code. I would check your fee schedule

I think 2w incision check and 6 wk PP visit is 'routine' for c/s, however you should check your state's medicaid provider guide as they usually advise how they want you to report these services. We don't bill for an incision check unless there is disruption or a major infection, etc.

 

[shieldsa]

For our medicaid provider, we are required to bill out E&Ms for prenatal visits, delivery only, and individual post partum visits. However, we bill 99024 for a one week incision check after a c-section. I was at a OB coding seminar recently and ladies from two different offices agreed that they did the same thing. We discussed and decided that a one week incision check could be billed but that each of our offices did not bill as a "good standard of practice" to the patients to be sure they are on the right road to healing.