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New to OB coding

  1. #1
    Default New to OB coding
    Medical Coding Books
    I am new to OB coding. My office is billing the 76801-76828 Obstetrical Ultrsound CPT codes, with office visits and United Health is denying the codes as global. When I spoke to United Health they said that the Ultrasound codes are being billed wrong. The office is applying the 26 modifier to the CPT codes for the OB Ultrasound. What are we doing wrong?
    here is an example of what the bill looks like:
    99242
    76811-26
    76812-26
    Thank you,
    Michele Lejeune

  2. Default UHC - payments for ob U/S
    There was a Network Bulletin sent out on Sept 21,2007 from UHC. For Claims with DOS on or after June 24,2007. Basically they will pay for one screening ultrasound. Subsequent ob ultrasounds will only be paid if there is a complication to the pregnancy. Effective 12/1/07 they will add V28.3 screening for malformation and V28.4 screening for fetal growth retardation to the list of diagnosis that they will pay subsequent ob ultrasounds on.

  3. Default
    when you are billing ob you cannot bill an office visit if the patient has anything but a state medicaid ins. You can only bill the ultrasound--which we usually bill 76805 around 20-22 wks gestation--if the patient needs any other ultrasounds because of lagging fetal weight or fundal height we would then bill 76815. You would really benefit from purchasing the book OB/GYN Coding Companion. It has been helpful to me for 12 years now. Hope this helps.

  4. Smile
    Quote Originally Posted by MLejeune View Post
    I am new to OB coding. My office is billing the 76801-76828 Obstetrical Ultrsound CPT codes, with office visits and United Health is denying the codes as global. When I spoke to United Health they said that the Ultrasound codes are being billed wrong. The office is applying the 26 modifier to the CPT codes for the OB Ultrasound. What are we doing wrong?
    here is an example of what the bill looks like:
    99242
    76811-26
    76812-26
    Thank you,
    Michele Lejeune
    Do you own the equipment for the u/s? Or is your physician reading/interpreting the u/s? The office that I work for, owns the equipment, and we would bill the above as:

    99242-25 (if a separate consult was actually done, and documented)
    76811
    76812

    This was for twins, right?

  5. #5
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    For United Healthcare all ultrasounds after the one allowed screeing ultrasound would need to have medical necessity established. If it is another "screening" they won't pay no matter how you bill. If there is a medical reason for doing the ultrasound....a problem...then use the appropriate diagnosis code. This is a United Healthcare policy so it does not apply to all other insurance plans.

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