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Thread: Billing "extra" visits for patients seen for complications of pregnancy (i.e.DM)

  1. #1

    Default Billing "extra" visits for patients seen for complications of pregnancy (i.e.DM)

    AAPC: Back to School
    We are getting denied while billing "sick" visits on our OB patients when seen for complications of pregnancy (i.e. Gestational Diabetes, Threatened Abortion, etc.). I have been billing w/ a mod -25 and a secondary DX of high risk pregnancy, but still being denied as included in Global OB, even after trying to appeal w/ office records. I am wondering if anyone has this problem, or maybe you can let me know what I am doing wrong! I have also seen some posts about holding these visits till after delivery, but not clear on that. Any insight with this would be great!

  2. #2
    Join Date
    Apr 2007
    Honolulu, HI


    in my experience, some of the insurances that only pay maternity using the global package (there are a select few insurances that want you to bill out all dos), will not pay anything pregnancy related (gestational diabetes) as something separate from the global OB care.

    Most of the carriers I deal with do not consider pregnancy related disorders or threated abortions as separate from the global OB package. I have seen the threated abortion code paid after the fact, but the patient did in fact lose the baby a few days later.

  3. #3


    Thanks for your response. Any thoughts about holding claims until after delivery. Ive heard if "total" visits exceed 13, then these types of "complication" visits are separately billable. Has anyone out there done this successfully???? Thanks!

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