Tricare OB observation claims through the ER

mikael00

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Can someone please help me with a HUGE problem I am having....

I can not get Tri-Care to cover OB (pregnant) women's E/M visits when they come in through the ER for observation. They usually come through the ER for false labor; they are then sent for observation. I have tried billing with 99 series E/M codes as well as G codes; they are still denying for "charge included in a paid service". When I talk to Tri-Care they state the patient is covered under a global charge through their primary OB doctor; however, these visits are observation in the ER! I don't know what else to do?? Do I need to bill with a -59 modifier??
Has anyone else run into this issue?? Please help!
 
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