Wiki Unrelated E/M in the maternity

[Partha]

Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?

Any inputs will be greatly appreciated.

 

[Mjones7]

Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?

Any inputs will be greatly appreciated.

Hello:

I would bill the appropiate E/M with the unrelated to pregnacy dx and a modifier -24. Best Wishes!

 

[Lisa Bledsoe]

All carriers have their own policies on this issue. UHC will pay if you use mod -25. I believe Aetna considers everything as inclusive to the global. I suggest checking the reimbursement policy for the patients insurance. Good luck!

 

[bonzaibex]

The unrelated dx & problem E&M code should be sufficient. A 25 modifier might be needed if you use a V22.2 as your secondary dx..........Rebecca Hardin, CPC