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Feds Propose to Expand Birth Control Coverage

New rules would amend an Affordable Care Act provision to allow more women to obtain contraceptive services at no cost. The Department of Health and Human Services (HHS) and the Departments of Labor and the Treasury (Departments) released new rules Jan. 31 that would amend the Affordable Care Act (ACA) regarding coverage of certain contraceptive […]

The post Feds Propose to Expand Birth Control Coverage appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Well Patient Visits with Birth Control

Female pt comes in, she would like to talk about birth control. We do all of the components of a well exam but no gyne exam for her as she already had that done one year ago. We bill 99395 with Z00.00. This is denied by a portion of our payers though because they only will not cover Z00.00 for a female.

I’m lost. I’ve checked with our payers but we all know they can’t tell us how to code. My doctor isn’t documenting counseling time, and most of our plans don’t cover 99401-99404 at a rate that is sustainable. $ 14.00 allowable for example for 99401.

99212 with Z30.09 causes many of our patients to be billed their copay or coinsurance because it isn’t being considered part of their preventive ACA benefits because we didn’t bill for 99395 or 99401 (example).

How should I be billing an office visit for birth control? What is everyone else doing for these? Should I be billing 99395 with Z30.09?

Medical Billing and Coding Forum

Neonatal consult prior to pre-term birth

Our neonatologist is asked to consult with pregnant mom who is hospitalized with issues causing the expectation of premature delivery. Neonatologist counsels Mom on risks of preterm delivery to baby and what to expect for baby once she delivers (respiratory management concerns, possible NICU stay, etc.). Neonatologist does not treat mom’s condition(s). What ICD-10-CM code should the doctor use to report this service for reimbursement? Is there a diagnosis code for this type of consultation or would we use the mom’s diagnosis that caused the threat of preterm delivery?

Medical Billing and Coding Forum

Medical Malpractice and Birth Injuries

What is more exciting than bringing a newborn into the world? After all, the future of mankind really does depend on our children and our children’s children.

Unfortunately, labor as well as delivery can be a very complicated and unpredictable process. When an expectant mother goes through the birth process she trusts that her doctors and other medical professionals will maintain the highest of standards as they help to guide her through the childbirth process.

Doctors have to be able to make instantaneous decisions in order to protect the safety and health of the newborn and its mother. When a trained physician or other medical professional fails to observe any warning signs – or when they deviate from accepted medical standards of care – children are often unnecessarily harmed.

Birth injuries can range from those that will heal themselves and have no long term adverse affects to extremely serious injuries that can affect a child’s brain.

If, during delivery, the baby lacks oxygen for one reason or another, or if there is any bleeding within the baby’s brain or skull, then serious birth injuries are often the result. And many of these birth injuries cause irreversible brain damage.

Oxygen shortages can be caused by a number of different things. The baby may be in an unusual birth position. Or the placenta may prematurely separate from the wall of the uterus. There could also be problems with circulation within the umbilical cord. In addition, labor may be either too short or too long.

Most of the medical malpractice claims that are based on injuries due to a shortage of oxygen allege that the medical professionals involved with the birthing process failed to recognize, anticipate, or react to any of these potentially dangerous scenarios.

Other factors that can lead to birth injuries include the failure to correctly anticipate the baby’s size, the use of excessive force during the delivery, not ordering a C-section when necessary, and others.

Roughly nine and one half percent of all the medical malpractice lawsuits involve either the failure to properly diagnose problems either before or while they are happening, or the misdiagnosis of problems related to child birth.

Two types of cases that are predominate in birth injury malpractice lawsuits involve either Cerebral Palsy (CP) or Erb’s Palsy (sometimes called Brachial Plexus palsy).

Because medical professionals have accepted the responsibility of taking good care of both the mother as well as the newborn child, if there has been a breach in their actions that caused injury to either they should be held accountable.

And, if you or your child is a victim of medical malpractice and you would like to contact a Birth Injury Lawyer, go to => http://www.sokolovelaw.com/legal-help/cerebral-palsy-and-birth-injuries/ Wendy Moyer on behalf of Sokolove Law.

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Birth Injuries and Medical Malpractice

When a couple is expecting a child, there are many considerations that must be taken into account. They spend time planning, decorating, and buying items for the new baby. Pregnancy requires classes, doctor’s visits, and preparation before the birth. Unfortunately, even the most prepared parents-to-be may discover complications during childbirth. Even more tragic is the fact that complications may be caused by mistakes made by medical professionals in the delivery room.

The risks to both mother and baby can be very high during childbirth. Studies show that nearly 9.5% of medical malpractice suits involve misdiagnosis or failure to diagnose problems involving childbirth. Victims often feel that the complications that arise during the birthing process could have been avoided if the issue had been identified and addressed in a timely manner.

Common Childbirth Injuries

Although there are countless issues that can arise during childbirth, some common complications include:

• Death of the fetus

• Physical injury to the child (including broken bones, bruising, internal bleeding)

• Stillbirth

• Maternal death

• Brain injury

• Cerebral palsy

• Paralysis

• Maternal infection

These injuries can cause severe pain and suffering and may have lifelong effects on the mother and baby. Medical professionals should practice the utmost care when dealing with any procedures, and especially so in the case of childbirth.

Some common cases of medical malpractice during childbirth include incidents where the physicians failed to notice metabolic disorders, blood issues, and complications involving diabetes. Other issues have included failure to monitor babies after childbirth, improper evaluation during pregnancy, and physicians arriving too late to help with childbirth.

Most individuals plan and prepare for a childbirth that follows normal procedure and expectations. Unfortunately, complications have been known to arise, and the issues may have serious effects on the family and patients.

The medical staff is responsible for conducting proper evaluations and tests during the pregnancy. During childbirth, they should be prepared to execute the delivery, properly handle the child during birth, and make sure both mother and child are healthy during the process. After the birth, they are responsible for handling the child, monitoring its health, and responsibly addressing any issues that may arise.

For more information on medical malpractice involving childbirth, visit the website of the Philadelphia birth injury lawyers of the Law Offices of Lowenthal & Abrams.

Joseph Devine

Related Medical Coding Articles

Emergency Room Birth

We do not normally deliver babies at our Critical Access Hospital, so this is not my forte. We recently had a woman deliver at 35-weeks in our emergency room. The baby was immediately transferred, by life flight, to larger hospital. My problem is coding the baby’s part of the ER. Someone here thinks I should assign 99460 to the chart, but I’m reluctant. The description states, "Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center." Would this CPT apply? If not, do I put an ER E/M code?
I applaud all of you who have to deal with this all the time. It’s like a foreign language to me.

Medical Billing and Coding Forum

Nitrous use in Birth Center: Moderate Sedation – July 2017 HBM Journal

In this months journal, the article on moderate sedation calculation excited the birthing center world with the possibility of being compensated for the use of Nitrous for laboring women. Currently patients have to pay out of pocket. While it’s a nominal fee, we would certainly like to cut down their out of pocket expense and also, the insurance is saving thousands by not having to pay an anesthesiologist for an epidural. Does anyone know if this coding methodology is permissible in this setting, and also, how would Nitrous (the supply) actually be billed? Since Nitrous is delivered as a mixed drug with O2, on demand it isn’t easy to measure with the devices available to outpatient facilities.

Medical Billing and Coding Forum

Initial or Surveillance for birth control pill change

A 17 year old patient was prescribed birth control pills for the first time and the diagnosis code used was Z30.011, encounter for initial prescription of contraceptive pills. The patient experienced side effects so a new prescription for a different pill was prescribed at her 3 month follow up. Is Z30.011 appropriate since it is a new prescription and pill type or would Z30.41, encounter for surveillance of contraceptive pills be correct?

After the initial prescription is written, is it ever appropriate to use Z30.011 again (e.g. whether repeat prescription or new pill type prescription at the ensuing annual visits)?

Thanks!

Medical Billing and Coding Forum