Wiki billing threatened abortion during OB global

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Charlotte Kay

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I need help, I am so confused. When you have a insurance pt that is in the OB global package and they have a threatened abortion scare. Can you or do you charge for that visit or will it too be a no charge. I am just confused because it is a problem. The pt can have several visits out of the normal, then everything return to a normal pregnacy. This would put it outside of the normal 13 OB visit limit.
 
Thank you

I have billed for them in the past, now we have insurances that are coming back and taking money back. Was just curious as to what other people were doing in this situation. However, with this new year, they are wanting money back for everything.....LOL. :D :rolleyes: :eek: Thanks for your feedback.
 
We are having a similare problem with Aetna in particular. We have laborists on duty and when we have patients come in with what amounts to "discomforts of pregnancy" we bill an office visit. Aetna has decided that is part of the global for delivery since these laborists are in the group and specialty of the patients regulare ob.

Has anyone else seen this lately, and if so have you been able to resolve it?
 
Charlotte Kay said:
I need help, I am so confused. When you have a insurance pt that is in the OB global package and they have a threatened abortion scare. Can you or do you charge for that visit or will it too be a no charge. I am just confused because it is a problem. The pt can have several visits out of the normal, then everything return to a normal pregnacy. This would put it outside of the normal 13 OB visit limit.
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Many payors may require that additional PNV's than exceed 13 be billed at delivery. Notice this BCBS policy:
BCBS OB policy for billable add'l E/M's: Additional antepartum E&M visits (in excess of 13) for a high risk complication that is active in the current pregnancy. These additional visits are to be submitted for payment only at the time of delivery. These visits must be submitted with a Modifier 25 and an appropriate high risk diagnosis.

 
morrisoncamille@yahoo.com said:
Many payors may require that additional PNV's than exceed 13 be billed at delivery. Notice this BCBS policy:
BCBS OB policy for billable add'l E/M's: Additional antepartum E&M visits (in excess of 13) for a high risk complication that is active in the current pregnancy. These additional visits are to be submitted for payment only at the time of delivery. These visits must be submitted with a Modifier 25 and an appropriate high risk diagnosis.

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Included in the Global Package:

Additional visits for a high risk pregnancy, potential problems, or history of problems that
do not actually develop or are inactive in the current pregnancy.
 
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