I have a claim that is denying from Medicare, our doctor billed a 99213 with dx Z32.01, O99.214, Z3A.36 and Z34.03. According to the progress note this is the patient's first visit to an OB and she 37 weeks. I am very new to OB coding (like this is my first ever OB claim). Can anyone give me insight on how to handle this issue? Thanks so much for any help!
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First OB appt late in pregnancy
- Thread starter akobasuk
- Start date
mitchellde
True Blue
first your dx codes are too many and you have not communicated the correct information.. you do not code the z32.01 with the O codes for pregnancy.. it is redundant to say positive pregnancy test and they have a pregnancy dx code. also the Z34.01 code is not to be used with the O codes, there are excludes 1 notes that tell you this. Now you need a code for the insufficient OB care so O09.33 is the first listed code, if obesity was documented the list the O99.213 (not 214) as the secondary code and the Z3a.37 as the weeks of gestation. The you need to know if this payer pays global OB or by the visit. If they pay global and most do the you use a dummy code for the visit .. such as 0500F for initial prenatal (0502F for subsequent) then you will bill after delivery using the code for the correct number of prenatal visits. If you have less than 4 prenatal visits you use visit level codes, but if you have 4 or more you use global delivery codes.