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Thread: Pre birth visit for expecting mothers

  1. #1
    Join Date
    Apr 2007
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    Unhappy Pre birth visit for expecting mothers

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    I wondering does anyone's ped. doctor bill for seeing a pregnant mother. There is dx code
    V65.11 Pediatric pre-birth visit for expecting mother

    We are currently seeing mothers and our doctors are billing as a consult, however our billing office is now saying we cant bill for this service. My problem is sometimes these visit take a while.My doctors review information regarding mothers pregnancy and any concerns or questions mom may have for our doc.

    So does anyone bill for this and if so do you have any problems with reimbursement and do you have any documentations that says this is valid to bill for?

    Thank you in advance for help

  2. #2
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    Default

    For one, it does not sound like this kind of visit meets the requirements for a consultation. Where is the request for an opinion, who are your doctors reporting back to, and who (mom or unborn child) is the opinion on? I would think that this type of visit could be billed with 99499 to the mother, but not as a consultation billed to the insurance.

  3. #3
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    Alexandria, VA
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    Smile

    Quote Originally Posted by EARREYGUE View Post
    I wondering does anyone's ped. doctor bill for seeing a pregnant mother. There is dx code
    V65.11 Pediatric pre-birth visit for expecting mother

    We are currently seeing mothers and our doctors are billing as a consult, however our billing office is now saying we cant bill for this service. My problem is sometimes these visit take a while.My doctors review information regarding mothers pregnancy and any concerns or questions mom may have for our doc.

    So does anyone bill for this and if so do you have any problems with reimbursement and do you have any documentations that says this is valid to bill for?

    Thank you in advance for help
    I bill for 2 Peds and they DONOT charge because insurances co's does not pay....We do it as a courtesy....


    YTH, CPC

  4. #4
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    Hamden
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    Default

    I work for a large pediatric group. We do not bill for these visits either.
    Christina Lee Wagner, CPC, CPC-H

  5. #5
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    Apr 2007
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    Loma Linda,CA
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    Smile what I found

    Thanks for everyone’s response, I ended up contacting the American Academy of Pediatrics and it seems some doctors are billing for this service. I don’t know if we will bill for this service knowing most likely the parent may pay for the visit. I do believe if we do bill it will be with code 99499
    Here was their response…


    RESPONSE:
    Pre-natal visits that are done as part of a "meet-and-greet" are not typically paid by carriers, because there is no medical necessity for the visit.
    However, in the case where the mother's OB-GYN is concerned that there might be an issue with the newborn and requests that the mom see a pediatrician to discuss this and give advice or opinion on how to move forward with the pregnancy/delivery, then that is a different issue. That is medically necessary and can be billed as a consult under the mom to the insurance with the primary diagnosis of the intrauterine condition and V65.11 as secondary.

    For parents that want to do a meet and greet, you have a few options. You can do that as a fee for service or perform this as a courtesy to parents as a marketing practice. Many have a fee-for-service set up as more and more parents are looking for these pre-natal visits.

    You cannot bill for a consult when the parent is the one who requests the meeting, because per CPT a parent or patient cannot initiate a consultation..

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