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59400 denied - "place of service on the claim is not appropriate"

Justin Posted Thu 23rd of April, 2020 20:45:00 PM
Hi! My wife had a baby, and I'm assisting the midwife in submitting the health insurance claim. The insurance company (HealthNet) has been extremely picky (lost the initial claim, rejected resubmitted claim due to incorrect CMS-1500 paper stock, etc.). It has taken 6 months of back and forth, and I finally learned that they rejected the claim stating "Location Code (11=Office) was not appropriate for code 59400". I plan on resubmitting with location code 10 (home) as the birth actually took place at home, but in the same call I was also told by the HealthNet representative that I would need to split out individual visits as line items. This seemed odd because in doing some reading on 59400 it seems that this is supposed to be a global code that contains multiple dates of service, thus the "service date range" on CMS1500 form. So, really, my question is, should I submit multiple lines of 59400 on the CMS-1500 form (one for each date of service), or should I simply submit 1 line and assume the person I spoke to was incorrect and didn't understand how 59400 works?
SuperCoder Answered Fri 24th of April, 2020 03:00:28 AM

Hi Justin,


You should bill CPT code 59400 under place of service "12" for services performed at home. You should bill this code as a single line item if your provider (midwife) has been the active participant during the whole delivery period and has provided antepartum care, performed delivery, and provided postpartum care as well.


If antepartum service was performed by a different physician, that particular physician would bill the appropriate antepartum visit code (59425-59426) as per the number of visits performed. In that case your physician would bill the appropriate CPT code for delivery along with post-partum care i.e. CPT code 59410.


If post-partum care has been performed by some other physician and your physician (midwife) performed only delivery, then she should bill CPT code 59409 for her services.  


Hope provided information would be helpful.



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