Wiki Need TX Billing Help - I have just begun billing

[klobo]

Hello,
I have just begun billing for a Medical Group in Pampa, TX.
I am based in CA and am well versed in CA billing.
I am looking for somebody who could provide me some guidance with billing for
TX Medicaid and any other nuances to watch out for in TX billing.
My e-mail is: klobo@lobosolutions.com
My phone number is: 858-513-1833 x101

If u prefer to communicate via AAPC - I can do this also.

My first question. When billing a surgical code for TX Medicaid - is there a modifier to be added to the first procedure on the claim form.
Do I bill:
59410
or do I need to add a MOD to get TX Medicaid to pay.

Thx
ken lobo

 

[airart]

TX Medicaid Billing Help for OBGYN Response

I found this online and might help you out. I will also email this to your email address.

Texas Medicaid will restrict any cesarean section, labor induction, or delivery following
labor induction to certain criteria for dates of service on or after September 1, 2011.
The implementation date has changed to October 1, 2011 and the list of criteria has
been updated. Following is the complete, corrected article:

Effective for dates of service on or after October 1, 2011, benefit criteria for obstetric delivery services will change for Texas Medicaid. Claims that are submitted for obstetric delivery procedure codes 59409, 59410, 59514, 59515, 59612, 59614, 59620, or 59622 will require one of the following modifiers:

Modifier To Indicate

U1 Medically necessary delivery prior to 39 weeks of gestation

U2 Delivery at 39 weeks of gestation or later

U3 Non-medically necessary delivery prior to 39 weeks of gestation

Note: Claims for deliveries that are submitted without one of the required modifiers will be denied. Effective for dates of service on or after October 1, 2011, Texas Medicaid will restrict any cesarean section, labor induction, or any delivery following labor induction to one of the following additional criteria:

• Gestational age of the fetus should be determined to be at least 39 weeks.

• When the delivery occurs prior to 39 weeks, maternal and/or fetal conditions must dictate medical necessity for the delivery.

Cesarean sections, labor inductions, or any deliveries following labor induction that
occur prior to 39 weeks of gestation and are not considered medically necessary will be
denied. Records will be subject to retrospective review. Payments made for a cesarean section,
labor induction, or any delivery following labor induction that fail to meet these criteria
(as determined by review of medical documentation), will be subject to recoupment.

Recoupment may apply to all services related to the delivery, including additional physician fees and the hospital fees.

For more information, call the TMHP Contact Center at 1-800-925-9126.