Wiki billable or inclusive

[bsrinivasarao777]

Hi, all I hope you all are doing well. I am new to OB coding …….

Here one of my OB provider had billed 99213 with O20.0 for a routine antepartum visit. This claim got denied as not payable and stated it will be inclusive within global service (59400 or 59510) .which is going to be billed in future.

Please I need your assistance on this weather it can be billable or inclusive.

 

[jdibble]

If your provider is providing the routine OB care, including the delivery for the patient, then this would be part of the OB global package. All visits, aside from the first visit if OB care has not begun, (usually the visit where it is determined that the patient is pregnant) will be included in the code you will bill for the delivery. This also includes the post-partum visit. If your physician sees the patient for a condition during the pregnancy that is not related to the pregnancy, then they could bill an E/M for that visit - with the diagnosis for that illness, and a modifier.

There are other scenarios where you could bill differently depending on the length of time the patient is under your doctor's care or who delivers the baby, etc. However you would not bill an E/M code for routine OB care unless your physician will only be seeing this patient for the one to three visits only. Billing for the OB package is all done after the delivery.

Hope this helps.

 

[CodingKing]

an O dx alone does not automatically qualify a patient to be highrisk patient where all service can be broken out. That only applies if non OB related condition (ie stubbed toe, slipped and broke leg) multiple physician groups are treating the patient, they switch providers mid pregnancy and patient who switch health plans mid pregnancy.

 

[bsrinivasarao777]

Thanks

Thanks for your help