High risk pregnancies with more than 13 antepartum visits

[maddalynni]

Hello,

Most all of the ob/gyn docs I work for have a number of patients that are requiring more than the global 10-13 antepartum visits for their care. Whether it be for poorly controlled gestational diabetes, pre-existing dm, drug abuse, etc., how does anyone out there bill for these extra visits and get them paid successfully? Please advise.

Thank you!

 

[dhoag]

This is a great topic of discussion. I will be curious to see if others comment about their experience. I find it challenging to get extra visits paid period. I have billed some of these visits out at the time of service and depending on the payer some get paid I have also waited until the end to bill and this can be tricky as well again depending on the payer and that the time does not exceed timely. It seems to me the majority get denied as global and it takes knowing the payer and their policy regarding payment for such. Some just take appealing which can be time consuming to say the least. I have learned with Providence if you bill for such a visit at the time of service and they pay this claim they may deny the global billing as included in another service, this has happened to me and I believe I am still fighting to get the global claim paid, so it really is helpful to know the policy of the payer. I know I did not answer your question but wanted to share my experience.

Donna

 

[ahguzman]

Refer to the payer's billing guidelines. In my experience, most commercial carriers have requested 22 modifier on the global delivery which will deny initially. Appeal and submit the OB flow sheet or progress notes to support the additional visits.

 

[lallembaugh]

Any antenatal visit above 13, we bill as an office visit with a 25 modifier, and have no issues getting paid.