Wiki Billing Question/Help Needed

[bugkk56]

I have a patient that had a miscarriage prior to 22 weeks, labor was induced and services were coded with CPT 59850. The insurance denied claim because of CPT 59850 and the physician is wanting code changed to CPT 59400. Can you do this? Can someone tell me where to find documentation on this to give to the physician?

 

[btadlock1]

I have a patient that had a miscarriage prior to 22 weeks, labor was induced and services were coded with CPT 59850. The insurance denied claim because of CPT 59850 and the physician is wanting code changed to CPT 59400. Can you do this? Can someone tell me where to find documentation on this to give to the physician?

59400 includes a Coding Tip in the Professional edition that says "Instructions for reporting Antepartum and Postpartum Care: The services normally provided in uncomplicated maternity cases include antepartum care, delivery, and postpartum care." (Emphasis added)

This is not "routine", or uncomplicated. The situation you're describing seems to fit better with 59850. I doubt that the denial is truly centered on the CPT code, itself. Why exactly did it deny? If it's not an issue with the patient's plan coverage, then the problem likely stems from the diagnosis billed with it, causing the service to be considered 'non-covered' in some way. What diagnosis was billed?

 

[bugkk56]

Sorry...the physician wants to change it to 59410. The diagnosis codes used for the original CPT code was 632 and V27.1. The fetal death prior to 22 weeks and delivery of stillborn.