Wiki OB Check and Fetal NST

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melheffley

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I need some advice on how to bill an OB check (99213.TH) with the physician along with a fetal non-stress test (59025) on the same DOS. Some of our insurance carriers (mainly the Medicaids) require us to bill each OB check individually. Up until this point, we have been billing the office call and the fetal NST on the same day with no modifiers required (with no problems I might add). We just found that Paramount (one of our Mediciad Advantage plans here in Ohio) does not want to cover the office call with the NST on the same DOS without any modifiers. I guess my question is, is it right for us to bill the office call with the 25 modifier when there is a NST on the same day? Even when the NST and OC are scheduled to be done? NONE of our other carriers have given us this denial. As a side note, the NST is only done when the physician feels the patient is high risk and needs additional fetal monitoring ie. PIH or GDM.
 
99213 & 59025

I'm searching for the same answer. We to are in Ohio and wondering if we can bill 99213 and 59025 to Medicaid. Do you use a 25 modifier? Have you had any luck since your post? Thanks!
 
We currently bill the NST (59025) to all of our carriers with the antepartum visit. They all seem to pay just fine, no 25 modifier involved. However, we just received something from Ohio Medicaid stating that they want money back from 2006 stating that the NST and office call cannot be billed together. We are still working to figure out the correct answer. I will be sure to let you know as soon (or if!) we ever do.
 
I also received notice from Medicaid that they want money back from 2008 for 59025 & 99213 being billed together. This is how all of our OBs bill out to traditional medicaid and we always get paid. I can not find anything to support their decision nor can I find anything to help if I were to try and appeal their decision. If anyone finds out any information - please post!! Thanks!
 
A contact at one of our other offices has told us that they have information from Medicaid which states that the antepartum visit along with other pregnancy related services can be billed togtther. She is supposed to be getting me this information. As soon as I can verify that it is legit, I will let you know!
 
Alright. So I think I have some good news for antepartum care/non-stress tests with Ohio Medicaid. :) Here is the information that I have been given that we are using. This comes from the Ohio Medicaid emanual:

Ohio Administrative Code (OAC) 5101:3-4-08 Covered Obstetrical Services
-Pargraph (B), section (2)
-Paragraph (D), section (2), (a)(iii): All obstetrical diagnostic procedures identifed in standard code sets.
-Paragraph (D)(2)(b): The services listed in paragraph (D)(2)(a) of this rule may be provided independently on any date of service, or they may occur sequentially on the same date as the antepartum visit or any other covered service.

According to this documentation, we feel that it clearly states (according to Ohio Medicaid and the OAC), that antepartum care can be billed on the SAME DOS as another obstetrical service (other than routine UA).

I hope this helps you guys out. Let me know if you have any concerns about the information.
 
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