AAPC - Back to school
Results 1 to 4 of 4

Thread: High Risk Pregnancies

  1. #1

    Default High Risk Pregnancies

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Watertown, NY


    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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
    AAPC of Kansas City
    National Advisory Board Representative Region 5

    Medical Revenue $olutions
    Senior Managing Consultant


Similar Threads

  1. High risk Rx ???
    By Orthocoderpgu in forum E/M
    Replies: 3
    Last Post: 07-31-2012, 04:42 AM
  2. High risk?
    By ktews in forum Gastroenterology
    Replies: 4
    Last Post: 01-19-2012, 08:34 AM
  3. Replies: 1
    Last Post: 02-16-2010, 12:59 PM
  4. High Risk
    By Jagadish in forum E/M
    Replies: 4
    Last Post: 08-12-2009, 04:05 PM
  5. Billing for high risk pregnancies
    By barbacasec in forum OB/GYN
    Replies: 0
    Last Post: 09-10-2008, 12:11 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.