Wiki Modifier TH

[neecen]

I have an office billing a mod TH on every OB visit. My online modifier handbook reads as follows:

TH Obstetrical treatment/services, prenatal or postpartum If a provider renders three or fewer antepartum care visits, the provider is required to include modifier TH with the appropriate E&M service code (99201-99215 and/or 99341-99350) to indicate that the code is being used for obstetrical treatment/services. If the services are HPSA eligible, the provider should include the HPSA modifier AQ in addition to modifier TH.

The office gets reimbursed more when they use the TH modifier. Am I misunderstanding something here? Is it carrier specific? If the office is correct in billing a TH modifier, can a mod 25 be added for an injection for RH negative mother?

 

[Bernadette10]

I have a question about mod TH also. I think it depends on the payer. Some payers will only pay for a certain number of outpatient clinic visits per year, and those with mod TH are excluded from this number since they're prenatal, so mod TH needs to be added to all prenatal visits. Does anyone know, if a payer requires mod TH on all prenatal visits, does this include prenatal observation visits when they're admitted to L&D for a few hours for something that's not routine, like excess vomiting or preterm labor? I'm thinking yes?

Example, this is what the Louisiana Medicaid billing manual says:
Except for prenatal visits modified with -TH, all visits performed at federally qualified health centers, rural health clinics, nursing homes, and skilled nursing facilities will be counted toward the 12 visits per calendar year for recipients over age 21. Nursing home and skilled nursing facility visits should be billed with the appropriate place of service and not as inpatient hospital.

Visits in excess of 12 per calendar year for which medically necessary extensions are not approved, are considered to be a non-covered Medicaid service and are therefore billable to recipients. An extension must have been filed and denied as not medically necessary in order for the visit to be billed to the recipient.