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High risk Cerclage follow up

  1. Default High risk Cerclage follow up
    Medical Coding Books
    We have some patients that are high risk and are being seen every week, after having a cerclage. Would these visits be billed seperatly or are the included in the global.

    And, I guess i have the same question for say diabetic or hypertension patients that are seen more often. do we include in routine and then count at the end, if there are more than 13 do i go back and bill visits.

    thank for the help

  2. #2
    They should be billable, but each carrier has their own policy on how they want this billed. UHC will pay for extra visits if the total exceeds 13 or 14 AND you have a complication dx, but our Aetna HMO contract states the patient must be enrolled in Aetna's High Risk Maternity Program, and then they reimburse a higher amount on the global OB code. I believe Anthem will pay for visits outside the usual routine time frame of 4 wk, 2 wk, then 1 wk, depending on the stage of pregnancy. These carrier policies may differ in your area.........Rebecca Hardin, CPC

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