I have an OP Note for a patient that was induced at 39 weeks. She had a diagnosis of Oligohydramnios and Small for gestational age fetus. The reason for induction is because her amniotic flud dropped to 4 and during an amniotomy there was no fluid noted. The delvery however went well, it was quick, no lacerations or problems of any kind. I cannot determine which code to use for the delivery. The Oligohydramnios O41.030 is third trimester, not delivery. The small for age fetus O36.5930 is the same situation, it is not a delivery code. The physician has also been adding O09.93 "Supervision of high risk pregnancy, unspecified, third trimester" to the office notes. How do I code a full term uncomplicated delivery with High Risk pregnancy?
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationaleTag Archives: High
Billing BCBS for extra prenatal visits for High Risk Patient
High risk pregnancies with more than 13 antepartum visits
Most all of the ob/gyn docs I work for have a number of patients that are requiring more than the global 10-13 antepartum visits for their care. Whether it be for poorly controlled gestational diabetes, pre-existing dm, drug abuse, etc., how does anyone out there bill for these extra visits and get them paid successfully? Please advise.
Thank you!
High Flow in Pediatrics
You Just Graduated High School. Now What?
Consider a career as a healthcare business professional. The hoopla of graduating high school is over, and now everyone is asking you, “What are you going to do next?” You might give the obligatory response, “Go to college,” because that’s what everyone expects. But is that the right answer? Learn a Trade that Pays Unless […]
AAPC Knowledge Center
Surgery for Medial Opening Wedge High Tibial Osteotomy w/allograft
Surgery for Medial Opening Wedge High Tibial Osteotomy w/allograft-Please help
Proton Cancer Treatment Centers: High on Price, Low on Return
Proton beam treatment is a particle therapy that uses a beam of protons to target and destroy cancer tissue. There are 27 proton beam units across the United States, and 20 more are popping up or under construction, including Mayo which has opened two, four-unit proton centers in Minnesota and Arizona. Upside The advantage of proton beam therapy over […]
AAPC Knowledge Center
Coding Clinic States use Z12.11 on High Risk Screening Colonoscopy???
The AGA in their GI CPT updates review states that audits have begun and take backs are happening on charges billed as routine screening colonoscopy when signs, symptoms or disease are in the medical record (personal hx of colon cancer and/or polyps is a condition). Also, I’m also thinking of the logistics of reporting screening turned diagnostic with this change (if it truly is valid). Currently a commercial high risk colon for personal hx polyps that removes a tubular adenoma by snare is reported 45385, 33 Z86.010, D12.* … it would now be reported as 45385, 33 Z12.11, Z86.010, D12.* ?? I’ve talked with many claims processors and a lot of clinical edits don’t go beyond the primary dx. It would be perceived as a routine preventive colon, not high risk.
I’m just afraid that everyone will start throwing the Z12.11 on ALL colonoscopies and payers will pay, waiving patient out of pocket, then audits will ensue and take backs will be recouped and billing departments will need to chase patients for the out of pocket expenses (and these take backs can occur years after the original billing). A personal hx of polyps, cancer, colitis, etc. allows patients to have more frequent screenings which classifies them as not routine.
Any links to literature that you’re aware of that is gold standard to support this change would be greatly appreciated. I did send a mesage to AskMueller to see if they could clarify their statement. I think payers should cover both routine and high risk colonoscopy 100% it’s ridiculous the different interpretations from payer to payer and policy to policy within the same payer. Some BCBSMi policies cover any kind of colonoscopy once a year with no patient out of pocket and then some others are grandfathered and screenings of any kind are not a benefit.
Thanks in advance for any feedback!!