NonHealthy Beginnings Medicaid Patient

[sjmccarl52]

My OB doc is not a participating physician in the Medicaid healthy beginnings program. We have been charging a 99214 level for each visit and then a delivery and postpartum care code when patient delivers. I'm not sure we are doing enough at prenatal visits to warrant a 99214. Does anyone else bill their Medicaid patients this way? Thanks.

 

[AHenderson]

I really have to question why you would charge such a high-level EM code for routine OB visits...in our office we usually charge a 99212 for routine OB checks, since they are usually just simple tummy and fetal heart-tone checks...according to CPT guidelines a 99214 requires 2 of 3 elements out of detailed history, detailed exam, and MDM of moderate complexity...I don't think routine OB checks qualify for any of these elements

That said, I understand that your doctor is non-participating in Medicaid and that Medicaid rates are ridiculously low and at times it almost does not seem to be worth the time or energy to take Medicaid patients...however, that does not mean that is it appropriate to bill higher-level EM codes that are not warranted