10-13-2017, 04:16 AM | Community Wiki

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Billing Delivery

  1. #1
    Default Billing Delivery
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    I work for a FQHC and we are recently receiving denials when we bill for our delivery charges from Caresource and UHC Community Plan. Normally we bill CPT 59409 with DX O80 (encounter for full-term uncomplicated delivery) and the outcome of the delivery, usually Z37.0 (Single live birth). The claims have always paid until recently and we are receiving a denial that the DX codes are inconsistent with the procedure. Am I missing something?

    Thank you!

  2. #2
    I found the following that may help:

    ICD-10-CM Coding Rules
    •O80 is applicable to maternity patients aged 12 - 55 years inclusive.
    •O80 is applicable to female patients.
    •O80 should be used on the maternal record - not on the newborn record.
    Use a code under Z3A to document the exact week during the pregnancy OR

    Reporting Birth Weight on Newborn Claims
    Please note that providers are required to report newborn weight to UnitedHealthcare Community Plan. To report this data, the appropriate value code must be used:
    UB-04: Report in block 39, 40 or 41 using value code “54” and the newborn’s weight grams. If billing electronically, please report birth weight in loop 2300, segment HI, with the qualifier BE and the value code “54” in HI01-2 and the newborn’s weight in grams in HI01-5.
    UnitedHealthcare Community Plan references the following codes to identify newborn claims.
    Therefore, please be sure to include birth weight on all claims containing these codes: ICD-10 Procedure Codes:ICD-10 Diagnosis Codes: 080 Normal Delivery. Z37.0 Outcome of Delivery

    Hope this helps.

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