10-13-2017, 04:16 AM | Community Wiki

Results 1 to 2 of 2

Billing Delivery

  1. #1
    Default Billing Delivery
    Medical Coding Books

    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
    Lexington, KY
    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 newborns 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 newborns 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.

Similar Threads

  1. Billing Delivery with Midwife and MD
    By LKaf7 in forum OB/GYN
    Replies: 0
    Last Post: 01-04-2017, 11:38 AM
  2. Billing for normal delivery
    By miriam j in forum OB/GYN
    Replies: 5
    Last Post: 04-01-2014, 12:52 AM
  3. Medicaid and billing Delivery
    By rmatthews in forum OB/GYN
    Replies: 1
    Last Post: 09-20-2012, 07:16 PM
  4. Billing OB Delivery
    By jallonk in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-11-2012, 07:28 AM
  5. Billing for normal delivery
    By miriam j in forum OB/GYN
    Replies: 1
    Last Post: 09-01-2010, 05:05 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.