Wiki Deliveries under 39 weeks

[rosezeron]

Starting January of this year, we started receiving denials from Amerigroup, stating that the delivery was not medically indicated when the child was born before 39 weeks. We need a diagnosis to indicate why the baby was delivered before 39 weeks. amerigroup will not tell you what diagnosis to use. There are a few diagnosis that I think could work but just wanted to see if anyone else has had this issue. O75.89 other specified complications of labor and delivery. 075.9 complication of labor and delivery, unspecified. 060.14 Preterm labor third trimester with preterm delivery third trimester (not sure these would be considered pre-term as the weeks of gestation were 37 or 38 weeks) 062.9 Abnormality of forces of labor, unspecified. 042.90 Premature rupture of membranes, unspecified as to length of time between rupture and onset of labor. Any help would be greatly appreciated.

Rose Zeron, CPC

 

[Bready]

deliveries under 39 weeks

Our physicians do delivery only to Amerigroup so I do not know if your situation is the same or if you are billing global delivery, but in April 2014, Amerigroup published a list of ICD9 codes "acceptable" for deliveries PRIOR to 39 weeks. Two of them listed are the pre-term labor/pre-term delivery and the premature rupture of membranes. If either of these codes apply to your case, you should be paid.

 

[swiedner7]

I don't deal with Amerigroup but anything after 37 weeks is considered normal full term pregnancy.