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Wiki billing non-pregnancy in patient care

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jebond123

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I have a claim question: One of our OB patient's developed pyelonephritis in her 32nd week of pregnancy and our Dr admitted her for 3 days. The insurance carrier, Blue Shield of CA, has retracted their payment stating this hospitalization is included in the global. I used ICD10 O23.03. I am now thinking that was not enough. Before I send a corrected claim, I wanted to be sure on what should be on the claim for ICD10 and, if appropriate, modifer.
Thanks
 
For additional antenatal visits billable outside global maternity, use -25.
If the pyelonephritis was a complication of pregnancy, your ICD 10 seems correct. There is a note on O23 to "Use additional code to identify organism (B95.-, B96.-)." I would also throw Z3A.32 on there.
If the pyelonephritis was unrelated to the pregnancy, then I would not use O codes.
Check your carrier policy as well. Oftentimes they will provide additional guidance about what is or is not included in the global maternity by THEIR definition.
There are a couple of OB experts on this forum who may chime in confirming or correcting my advice.
 
I had this as well with a different carrier and sent in a corrected claim with the N10 code for acute phelonephritis also add the Z3A.32
 
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