Wiki Midwife billing with Medicaid

[nancyh4100]

We are having a discussion concerning our Midwifes and how the claims are being billed to Missouri Medicaid. Can we bill for the symptom being treated for the pregnancy instead of the Encounter for supervision of normal pregnancy and still have Medicaid pay for the office visit? Here is an example: Z34.02 Encounter for supervision of normal pregnancy, O22.42 Hemorrhoids in Pregnancy. Can the Hemorrhoids be the primary diagnosis and take off the Encounter DX?

 

[mitchellde]

If you look in the code book under category Z34 there is an Excludes 1 note that excludes coding any O code with any Z34 code. Therefor you would never code the Z34.02 with the O22.42 code for any payer. So use only the O22.42 code if the documentation supports this code. Whether MO Medicaid will pay this encounter, I am uncertain, all I can tell you is it was paid when I worked there.