• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Denied Prorated OB charges

Create Wiki
A

AMBERANDERSON

Contributor
Messages
19
Location
Sandy, OR
Best answers
0
When we have a patient with an insurance change or transfers in or out of our office for maternity care, we have to then prorate her ob charges. If a patient is seen for under 4 office visits, you have to bill out an E&M code like 99213. In the past, we have always billed this with a note on the claim stating "Prorated due to insurance change in pregnancy" or "Prorated due to transfer of care in pregnancy". The insurance companies choose to either just process the claim or deny for needing more information. If this happens we call, explain the reason, and they reprocess the claim. Recently, we have received denials from Lifewise, UHC and Aetna stating we need to attach modifier "TH" to the claim for processing.

I have been billing for an OB/GYN office for 6 years and have never come accross this before. Can someone please tell me if they have heard of this before?

Thanks!
 
You must log in or register to reply here.
Top