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Posted By Deborah Roorda on 06-11-2019, 13:46:51 in Ob-Gyn
Pt had placenta accrete diagnosis at delivery. She had to stay 5 extra days in hospital for conservative treatment w/augmentin for 5 days and observation for bleeding and infection. The doctors want to charge separately for these visits. Her insurance is UHC. Is this appropriate? Also, she will be having weekly office visits and ultrasounds, I know I can bill ultrasounds, but what about the visits? Would the diagnosis be O90.89 or O9989 with O73.0 & O43.219? Thank you for your help.
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Posted By Melanie Witt on 06-15-2019, 18:27:34
You should be able to bill visits for complications in the hospital, but UHC may require additional information before they agree to reimburse visits over an above the usual number of follow-up visits in the hospital for global billing. Again, if she is being seen for follow-up to the placenta accreta and not the pregnancy then these visits can be billed - but again check with UHC policy at: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Obstetrical-Policy.pdf

Per this policy: UnitedHealthcare will separately reimburse for E/M services associated with high risk and/or complications when modifier 25 is appended to indicate it is significant and separate from the routine antepartum care and the claim is submitted with an appropriate high risk or complicated diagnosis code.

O43.219 is not appropriate since the trimester is not longer an issue, not that you do not know the trimester. I would go with o99.89 and o73.0
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