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High Risk Pregnancies

  1. Default High Risk Pregnancies
    Medical Coding Books
    Evidentally I am having problems with billing for high risk pregnancies. Wondering if anyone has any suggestions, or real answers. I know with private payers alot of things fall in the global, if you have problems not associated with pregnancy those visits can be billed. A physician of ours is arguing withe me that he should be able to bill for more than a delivery if he has a high risk patient that needs more care. I know for ultrasounds that they can be billed with the diagnosis that is needed. If any one does high risk pregnancies on a day to day basis, could you please offer some suggestins.


  2. #2
    Problems not associated with pregnancy can be billed. you will need to add a modifier 24 to the E&M visit code.
    If the pt is seen more than 13 times for OB care we will add a modifier 22 to the delivery code and increase the price. I dont remember where i heard or saw to do this but if i find it i will send the link. but you need to watch that the insurance reimburses you a higher amount & if not it usually requires a letter form the dr stating why this OB care was above and beyond normal care.
    good luck

  3. #3
    Greeley, Colorado
    The way I understand modifier -22 is that it only applies to the delivery. If a patient has "extra" visits because of high risk comlications then those should be coded with the complication dx code at the time of the visit. It's VERY difficult to get the additional reimbursement for these visits so documentation must be clear that these visits are outside of the normal "routine" OB visits.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Kansas City, MO
    Just to add, look at your payer policies as well. Companies like BCBS, Coventry and UHC have very detailed policies that sometimes will explain how to bill High Risk pregnancies. I have taken info from each companies website based on our contracts and made an Excel spreadsheet to help our offices.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

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