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Medicare maternity

  1. #1
    Default Medicare maternity
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    I am receiving some conflicting information and need to know the proper way to bill Medicare for pregnancy services......globally or individual visits? Our FI is Palmetto GBA. Thanks!

    Lisa

  2. #2
    Location
    North Carolina
    Posts
    3,126
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    Most surgeons and obstetricians bill patients an all-inclusive package charge intended to cover all services associated with the surgical procedure or delivery of the child. All expenses for surgical and obstetrical care, including preoperative/prenatal examinations and tests and post-operative/postnatal services, are considered incurred on the date of surgery or delivery, as appropriate. This policy applies whether the physician bills on a package charge basis, or itemizes the bill separately for these items.

    Occasionally, a physician’s bill may include charges for additional services not directly related to the surgical procedure or the delivery. Such charges are considered incurred on the date the additional services are furnished.

    The above policy applies only where the charges are imposed by one physician or by a clinic on behalf of a group of physicians. Where more than one physician imposes charges for surgical or obstetrical services, all preoperative/prenatal and post-operative/postnatal services performed by the physician who performed the surgery or delivery are considered incurred on the date of the surgery or delivery. Expenses for services rendered by other physicians are considered incurred on the date they were performed.

    Section 20.1

    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

  3. #3
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    Yes, I read this, but the Medicare rep told us that we should bill individual visits, which is how SC Medicaid requires OB billing. One of my billers also accidently billed a high-risk ob visit to Medicare, and they paid it. It was a 99214 with dx V23.89 and the reason for the high-risk. That's why I'm questioning. Does it make a difference with Medicare if it's high-risk or not?

    Lisa

  4. #4
    Location
    North Carolina
    Posts
    3,126
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    Well...then I need to become familiar with Palmetto's guidelines for maternity. Recently, we acquired an OBGYN office and on top of that, Palmetto won the Medicare contract for NC (still in the process). Look's like I have some research to do.

  5. #5
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    My own coding instincts tell me to bill globally; I think I'll call Medicare again tomorrow to see if I get the same answer I got before! I just couldn't believe I couldn't find more information on this from Medicare, they are so picky about everything else! I'll let you know what I find out.

    Lisa

  6. #6
    Location
    Columbia, MO
    Posts
    12,561
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    I just have to ask.. You have Medicare patients that are pregnant?? I am not saying it is impossible but I am interested. As far as Medicaid goes I have had several different state Medicaids want OB billed as a per visit and not global.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    Although our patient wasn't 65yr she did have Medicare and I believe we billed out her pregnancy as global. And Florida Medicaid requires we bill per visit not global.

  8. #8
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    She's disabled and pregnant......we also have to bill Medicaid for individual visits.

  9. #9
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    When it comes to medicaid billing, I am under the impression that it is billed per visit. Now can a confirmation of pregnancy be billed 992XX with the appropriate icd of V72.40 - 42 or does the H1000 get billed that first visit?

    Thank you,
    Ivonne, CPMA

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