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Wiki Billing 01967 and 00940

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danachock

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Help requested please...
I have two different denials with this same scenario.
Patient has a vaginal delivery. Afterwards due to retained placenta or hemorrhage they were brought to the OR for a D&C.
I almost want to put a modifier on it because of the global period, but the one I keep wanting to use is the 59 and my gut is telling me it isn't right.
Could anyone offer any insight or thoughts on this please?
Thanks,
Dana Chock CPC, CCA, CANPC, CHONC
 
I would say that it does depend on carrier. Some Medicaid ob programs don't cover anything that is not actual delivery, so you would bill to two different carriers, the ob program and the regular Medicaid or selfpay if the patient doesn't have regular Medicaid.

Are the delivery and the d&c on the same day, but separated by a significant amount of time? IF so, you could bill the D&C with a 59. The labor epidural and the D&C will have different diagnoses to justify medical necessity.

If they are fairly close together you may be able to bill as discontinuous time.

I would suggest first and foremost, checking with your carrier to find out what rules they have on multiple procedures, ob and discontinuous time.
 
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