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Wiki 99232 denied due to global from 59510

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chwerin

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Triplet pregnancy, patient was admitted to hospital, doctor saw her every day on his rounds, documented and billed 99232. Within 30 days of being admitted an emergency c-section was performed and now insurance is denying the many 99232 visits as they are included in the global of 59510. Is this correct? Any help you can offer is appreciated! Thank you.
 
59510 is a package deal. If there is no medical necessity documented to support why the 99232 were justified from antepartum, delivery and postpartum care they are not reportable separately.

Per ACOG coding guidelines, if a patient sees an obstetrician for extra visits to monitor a potential problem and no problem actually develops, the physician is not to report the additional visits; only E/M visits related to a current complication can be reported separately.

Why did he need to round on the patient beyond routine care, was there an identifiable problem? Modifier 25 may be a carrier preference so review the carriers policy. See the example below for reference.


https://www.oxhp.com/secure/policy/obstetrical_policy.pdf
 
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