Billing

November 10, 2016 Health

Antepartum Visits
Normal antepartum visits are reported with ICD-9 codes as either V22.0 or V22.1. If there is a complication of pregnancy, the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code.

Antepartum visits begin with the first visit by our OB providers (OB Intake) for antepartum care.

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Less than 4 total antepartum visits we must bill appropriate E&M:
For less than 4 total antepartum visits, we are to use appropriate E&M services. Providers should determine the appropriate level of service. The billing staff will provide the Antepartum Care form along with a copy of the original router and visit documentation. Providers will determine the level of care for each date of service. Normal antepartum visits are reported with ICD-9 codes as either V22.0 or V22.1. If there is a complication of pregnancy, the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the ICD -9 code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code. These visits should be billed under the provider who provided this service. If a NP, PA or Midwife provided the service and is not credentialed with the carrier we are billing, the appropriate supervising provider should be listed on the claim form as the provider.

4-6 antepartum visits procedure code 59425.
If a patient receives a total of 4-6 antepartum visits, we will bill Medicaid carriers (FQHC) with procedure code 59425 and the appropriate ICD-9 code (usually V22.0 or V22.1 for normal antepartum visits). If there is a complication of pregnancy, the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the ICD-9 code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code. We will also bill this to other carriers if we do not provide delivery services and the post-partum care. This service should be billed under the provider who was involved most in the patient??™s care.

7 or more antepartum visits bill procedure code 59426.
If a patient receives a total of 7 or more antepartum visits, we will bill Medicaid carriers (FQHC) with procedure code 59426 and the appropriate ICD-9 code (usually V22.0 or V22.1 for normal antepartum visits). If there is a complication of pregnancy, the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the ICD-9 code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code. We will also bill this to other carriers if we do not provide delivery services and the post-partum care. This service should be billed under the provider who was involved most in the patient??™s care.

Medicare FQHC Antepartum

If a patient has Medicare, we must bill regular E&M visits for each antepartum visit based on the work that went into the visit. If the patient was new to CFH or had not been seen in the past 3 years you may bill a new patient visit for the first visit and then bill established patient visits for each antepartum visit and also the post partum visit.
The reason we bill this way for a Medicare patient is due to the fact that we are a FQHC and we must bill UGS Medicare for payment rather than Medicare Part B. Services provided at the hospital are billed to Medicare Part B.

Antepartum Visits (Continued)

Antepartum care exceeding 13 or more visits and patient has a high risk diagnosis:
If a patient is assigned to a Medicaid carrier (FQHC) we should bill an appropriate E&M for visits beyond 13 antepartum visits.
Providers should determine the appropriate level of service to be billed. The billing staff will provide the Antepartum Care form along with a copy of the original router and visit documentation. Providers will determine the level of care for each date of service. This should only be billed if there is a complication of pregnancy (high risk); the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the ICD -9 code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code. Visits beyond 12 visits should be billed only if the patient is considered high risk at that visit and billed under the provider who provided the service on that date.

Antepartum care exceeding 12 or more visits for BCBS and patient has a high risk diagnosis:

If a patient has BCBS we should bill an appropriate E&M for visits beyond 12 antepartum visits.
Providers should determine the appropriate level of service to be billed. The billing staff will provide the Antepartum Care form along with a copy of the original router and visit documentation. Providers will determine the level of care for each date of service. This should only be billed if there is a complication of pregnancy (high risk); the appropriate ICD-9 code should be used and coded to the highest level of specificity. Providers may indicate the ICD -9 code or provide a written description of the diagnosis and the billing staff will assign the correct ICD-9 code. Visits beyond 12 visits should be billed only if the patient is considered high risk at that visit and billed under the provider who provided the service on that date.

Different carriers during same pregnancy:
If a patient has Medicaid for part of the antepartum care and coverage from another carrier for the remaining portion of the pregnancy or vice versa, you should bill based on above rules depending on the quantity of visits provided while covered by that carrier. If you have any doubt ??“ please check with supervisor/manager of the Patient Accounts Dept.

Other requirements:
All carriers require:
LMP (last menstrual period): This needs to be listed in F3, field 6, F11, field 10. (Illness/injury field) for all carriers.

Antepartum Visits (continued)

Antepartum specific instructions per Medicaid/Medicare FQHC Carrier:
??? Great Lakes Health Plan: Use last prenatal visit as date of service. List quantity of visits and file electronic.

??? Health Plan of Michigan: Use from and to dates. Handwrite all dates of antepartum care in box 19 of the claim form (CMS 1500) and send hard copy claim.

??? Medicaid and MOMS: Use first prenatal visit as date of service. List quantity of visits and file electronic.

??? Medicare: Use last prenatal visit as date of service. List qty and file electronic.

See instructions for Commercial/BCBS (non-Medicaid/non-Medicare carriers) for specific instructions in billing on page four of this guide.

Delivery Billing
Delivery for the above insurance types should be billed depending on the type of delivery provided:
??? 59504 Vaginal Delivery only with or without episiotomy and/or forceps.
??? 59514 Cesarean delivery only.
??? 59612 Vaginal Delivery only, after previous cesarean delivery with or without episiotomy and/or forceps.
??? 59620 Cesarean Delivery following attempted vaginal delivery after previous cesarean delivery.

Postpartum Care Billing
??? Post-partum care 59430
??? Post-partum care 59430 should be billed after the office post-partum visit is provided. This must occur within 21 ??“ 56 days of delivery date.

Global OB Billing Codes:
For Commercial/BCBS (non-Medicaid/non-Medicare carriers):
??? The global code should be billed if we provide antepartum, delivery and post-partum care (see CPT code book).
??? We should not bill the global code until we provide the post-partum care in the office.
??? If we do not provide the post-partum care or the patient does not receive delivery from a CFH provider, you may bill the separate components for services we did provide as we do for Medicaid and Medicare. Refer to instructions listed previously in this document or check with supervisor/manager of Patient Accounts Dept.

Global obstetric codes (use when billing Commercial/BCBS and we provide all components of care) are as follows:
??? 59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care.
??? 59510 Routine obstetric care including antepartum care, cesarean delivery and postpartum care.
??? 59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care after previous cesarean delivery.
??? 59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care after previous attempted vaginal delivery after previous cesarean delivery.

Antepartum visits for commercial (if billing separate components):

??? BCBS: Use first antepartum visit as date of service and hand write all dates of service in field 19 of the claim form. Form needs to be submitted hard copy.
??? BCN: Use last antepartum visit as the date of service and list quantity of antepartum visits ??“ file electronic.
??? Commercial: Use last antepartum visit as the date of service and handwrite all dates of service in field 19 of the claim form. Form needs to be submitted hard copy.
??? Specific Commercial Carrier instructions ??“ contact carrier directly, look up on Web Denis, or discuss with supervisory/manager of Patient Accounts Dept.

Postpartum Visit (if billing separate components to Commercial/BCBS):
??? Post-partum care 59430
??? Post-partum care 59430 should be billed after the office post-partum visit is provided. This must occur within 21 ??“ 56 days of delivery date.
Please refer to CPT code book, Medicaid Provider Manual, Medicaid FQHC Provider Manual, ICD-9, Code link for OB/GYN, Web Denis Web Site, or contact individual carriers for more information on above. Please also check with supervisor/manager of Patient Accounts if you have further questions.

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