009.521 (supervision elderly pregnancy, 1st trimester) and Z3A.10 (10 week) and 036.8391 (unable to hear heart tones) - What modifiers do I need to use and which DX do I use to have the OV and the US paid? Thank you - VERY new to OB billing.
In billing for the ultrasound you assign the code which is the reason for doing it. In this case, unable to hear heart tones. But I would report O36.80 instead (fetal viability) as the code O36.8391 implies there is a heart beat but it is abnormal. O36.80 on the other hand states you are doing it to see if there is a viable pregnancy (especially at 10 weeks). You secondary code on the ultrasound will be Z3!.10. I would not report O09.521 as the first listed diagnosis in support of the the ultrasound.009.521 (supervision elderly pregnancy, 1st trimester) and Z3A.10 (10 week) and 036.8391 (unable to hear heart tones) - What modifiers do I need to use and which DX do I use to have the OV and the US paid? Thank you - VERY new to OB billing.
As she was new and she was establishing/starting ob care you would not bill the E/M service unless the ultrasound showed no heartbeat in which case there is no viable pregnancy. If she is continuing care with the practice (because the ultrasound showed a heart beat), you can try and bill the E/M service, but my experience tells me you will get a denial for the E/M.Thank you. This is a new patient to our practice - a OBGYN. At a first NOB appointment, there was no heart tone when one should have been determined by that date. So an US was performed. The physician has the 3 DX codes and the 2 procedure codes. To be sure - you're saying, OV can be tied to establishing care/pregnancy (Z3A.10) and the US tied to 036.80 (fetal viability) - and no modifier. Correct?
If not - I'm confused. I'm sorry. I do want to understand the nuance.
Side question I was about to post after looking through the threads/history - can you answer this unrelated question?
Pregnant patient establishes pregnancy care in another office/another provider - same insurance throughout pregnancy. She transfers to our office - new provider/new office. The initial visit should be to establish care with our office so we can do the intake - E&M 99203 with Z76.89 (encounter to establish care with a new provider). However, she would be in the global and the insurance would have paid the original provider/office the E&M code to establish the pregnancy. We would NOT code to establish the pregnancy, but to establish the patient only. Is this allowed since she is in the global period? Some pay - some don't. Any nuance about the "why some do and some don't" would be greatly appreciated.