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Unrelated E/M in the maternity

  1. #1
    Default Unrelated E/M in the maternity
    Medical Coding Books
    Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?

    Any inputs will be greatly appreciated.

  2. #2
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    Quote Originally Posted by Partha View Post
    Patient is being seen by OB dr in the antepartum period for a condition unrelated to the pregnancy. This is billable with an E/M code however insurance might bundle the E/M code in the global maternity package as the same provider is going to do the delivery and postpartum service. Is it just an unrelated dx with the E/M code is sufficient or a mod 25 is required?

    Any inputs will be greatly appreciated.
    Hello:

    I would bill the appropiate E/M with the unrelated to pregnacy dx and a modifier -24. Best Wishes!
    Mjones7

  3. #3
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    All carriers have their own policies on this issue. UHC will pay if you use mod -25. I believe Aetna considers everything as inclusive to the global. I suggest checking the reimbursement policy for the patients insurance. Good luck!
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    The unrelated dx & problem E&M code should be sufficient. A 25 modifier might be needed if you use a V22.2 as your secondary dx..........Rebecca Hardin, CPC

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