Regarding claim modifier -TH for antepartum/postpartum visits billable as E/M.
TH - Obstetrical treatment/services, prenatal or postpartum
A provider appends modifier TH when a female patient receives medical care for problems related to her pregnancy and following the birth of the child.
Explanation
This modifier indicates that a female patient receives medical care for problems related to her pregnancy and following the birth of the child.
The provider may render requisite treatment for the various aspects of pregnancy, including monitoring the health of the mother and providing medical support for the recovery of the mother following a cesarean or normal delivery.
I personally am interpreting the above from a coding perspective that -TH is appropriate on ANY E/M maternity visit, whether routine or non-routine (like for MFM specialists for example). We are in the process of an automated build for any E/M with a maternity diagnosis by an ob provider to auto-append -TH. This avoids the problem of relying exclusively on the provider to remember to add -TH on all the maternity visits.
However, Aetna has come out with a policy stating the opposite. "Non-routine prenatal and postpartum E&M office visits shouldn’t be submitted with modifier TH...."
I would love to hear opinions of anyone and everyone about the interpretation of when -TH is appropriate. And what steps you are taking within your offices and organizations.
TH - Obstetrical treatment/services, prenatal or postpartum
A provider appends modifier TH when a female patient receives medical care for problems related to her pregnancy and following the birth of the child.
Explanation
This modifier indicates that a female patient receives medical care for problems related to her pregnancy and following the birth of the child.
The provider may render requisite treatment for the various aspects of pregnancy, including monitoring the health of the mother and providing medical support for the recovery of the mother following a cesarean or normal delivery.
I personally am interpreting the above from a coding perspective that -TH is appropriate on ANY E/M maternity visit, whether routine or non-routine (like for MFM specialists for example). We are in the process of an automated build for any E/M with a maternity diagnosis by an ob provider to auto-append -TH. This avoids the problem of relying exclusively on the provider to remember to add -TH on all the maternity visits.
However, Aetna has come out with a policy stating the opposite. "Non-routine prenatal and postpartum E&M office visits shouldn’t be submitted with modifier TH...."
I would love to hear opinions of anyone and everyone about the interpretation of when -TH is appropriate. And what steps you are taking within your offices and organizations.