Wiki Miscarriage_Billing E/M day before Admit @ outside facility requiring D&C of Placenta

[centralizedcoding]

QUESTION: I have a provider on maternity leave and our other providers are trying to figure out how to collect their portion for seeing these pts while she is on leave. I have a pt that started her OB care w/ us and only had 4 visits total (2 visits routine ob care & 2 billed as problem visits) prior to the pt unfortunately having miscarriage where she (per hospital records) delivered upon arrival to hospital then required D&C for retained placenta. Her last visit was with us on 8/17, then had D&C at outside facility from us on 8/19. I originally opted to not bill the visit we did on 8/17 considering records reflected she was admitted to outside facility the very next day on 8/18 as insurance will often deny visits leading up to surgeries like this. I am being told that I can bill problem visit we seen pt for on 8/17 and just add modifier since the D&C was performed by outside provider. Does this sound correct? Or is there a different way of going about this? TIA!!

 

[CBLENNIE]

Why wouldn't you bill the code for 4-6 antepartum visits 59425? If I'm understanding your post correctly, the provider that saw the patient 2xs before going on maternity leave and the physician who covered for the physician on maternity leave saw the patient 2xs, both work for your group practice. If so, it would be appropriate to bill the 59425 - antepartum care only 4-6 visits, and your group practice should be reimbursed for providing all 4 visits.

It would be inappropriate to bill 4 individual E&M services for each visit because regardless of the of the nature of the visits, routine vs. problem visits, your group practice provided 4 antepartum visits and these services should be billed with the 59425.

 

[centralizedcoding]

Why wouldn't you bill the code for 4-6 antepartum visits 59425? If I'm understanding your post correctly, the provider that saw the patient 2xs before going on maternity leave and the physician who covered for the physician on maternity leave saw the patient 2xs, both work for your group practice. If so, it would be appropriate to bill the 59425 - antepartum care only 4-6 visits, and your group practice should be reimbursed for providing all 4 visits.

It would be inappropriate to bill 4 individual E&M services for each visit because regardless of the of the nature of the visits, routine vs. problem visits, your group practice provided 4 antepartum visits and these services should be billed with the 59425.

Thank you for your response! My reasoning for breaking up all the visits is because only 2 of those visits were routine prenatal visits and the other 2 were problem visits not documented in the pts prenatal flowsheet nor was there any documentation that routine care was provided in addition to the problem visits being done. Does that make sense? Or am I incorrect in my thinking of that?

 

[Cmama12]

Thank you for your response! My reasoning for breaking up all the visits is because only 2 of those visits were routine prenatal visits and the other 2 were problem visits not documented in the pts prenatal flowsheet nor was there any documentation that routine care was provided in addition to the problem visits being done. Does that make sense? Or am I incorrect in my thinking of that?

You are thinking about it correctly. However, since you only have two routine prenatals, those would be billed as e+m, so now you have 4 e+ms being billed, which is a bit unusual. I guess you may need to be prepared to appeal. Also regarding the 8/17 visit, if the patient had a procedure at an outside facility, and not one of your doctors, you would not need a modifier.