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Posted By Gracie Ermitano on 02-20-2018, 21:23:39 in Ob-Gyn
Hi Melanie i just want to confirm if the visit status post delivery of a dead fetus at 36 wks is billable as a separate visit. The patient was seen at the time of delivery only at 36 wks ( no prenatal visits) due to IUFD with provider billing for a vaginal delivery code 59409 with dx code O36.4XX0, Z3A.36 and Z37.1. Then 13 days post delivery pt was seen again and per notes discussion of lab results. Provider billed for a 99204-24 and insurance denying the visit for invalid modifier. Biller called and was advised to change the 99204 to mod 58 which is not correct. Provider gave the dx linkages as O09.299 with the EHR description of history of fetal death (this is a supervision of dx code and not to be used when the pt already delivered), D68.59 for protein S deficiency and N89.8 for leukorrhea. With protein S deficiency it is a rare inherited thrombophilia often associated with pregnancy losses and intrauterine fetal death. Leukorrhea or vaginal discharge is an expected finding and will continue through the postpartum unless significant. Provider spent 40 minutes counseling with extensive discussion of etiologies of iUFD; lab results reviewed in detail and will recheck thrombophilia panel. Advised closed follow-up for the next succeeding pregnancies. Is this is a billable visit and if so pt would be an established patient? Thank you very much. Very respectfully, Gracie
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Posted By Melanie Witt on 02-21-2018, 15:09:16
I am not sure why you billed a modifier at all. 59409 only includes the delivery and NO postpartum visits (either inpatient or outpatient). The usual global days do not apply to this code. Now if they objected to 99204 since he was the delivering MD I could see that because technically he did provide a face-to-face service to this patient within the past 3 years even though the admission H&P is bundled into 59409. This definitely is a billable service, but as I said, no modifier should have been added to the 99204.
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