Wiki Annuals and Office Visits billed prior to Delivery being taken back by BCBSM.

[dlohr01]

I have several claims that I have been paid for the annual or office visit. The patient then becomes pregnant shortly after and we bill the Global Delivery code. BCBSM will pay for the delivery, then come and take back the payment for Annual or Office visit. (stating it was during the global period of delivery, this is false in most cases we did not know that patient was pregnant at the time of service.) I have called asking how I can get these paid and they are stating I am missing a modifier. Does anyone know what modifier I should be attaching to the corrected claims. I have tried Modifier 24 and 79 and was told that they are both incorrect. Any help would be greatly appreciated.

 

[ELBrock]

Since the pregnancy was not the cause of the visits, I would think the Diagnosis code should separate those services from the global OB package. Per UnitedHealthcare's OB reimbursement policy: "The diagnosis code used in
conjunction with the E/M service should support the non-OB condition being treated and/or evaluated. UnitedHealthcare will reimburse non-OB related E/M services rendered during the antepartum stage of care only when the appropriate diagnosis code being used clearly identifies the condition is not related to pregnancy care."
The global delivery code should only be used if you've supplied all the Antepartum care (usually 13 visits). I believe it is payer specific how many antepartum visits are needed to be able to bundle them to the global package, but it's standard that 1-3 are billed with E/M codes only.
Perhaps using DX Z33.1 would help, showing the service is incidental to the fact that the patient is pregnant? I see why modifiers 24 and 79 wouldn't work as they are for services during Post-operative global periods.