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Annie Posted Tue 22nd of April, 2014 16:06:55 PM

If patient is pregnant and has Medicare and Medicaid do we us the Th modifier?

SuperCoder Answered Wed 23rd of April, 2014 10:22:05 AM

The TH modifier indicates that the prepaid postpartum visit was performed as originally intended, meets HEDIS® Standards and confirms if services were rendered within the 21 to 56 days after the delivery.

Payment of delivery and Postpartum Care
E/M codes may not be used when reporting postpartum visits and will be denied. Effective 6/27/11, Providers must bill a delivery code that includes the postpartum visit when the physician intends to provide postpartum care. The CPT® codes that include delivery and postpartum care are:

59410: Vaginal delivery including postpartum care
59515: Cesarean delivery including postpartum care
59614: Vaginal delivery after previous cesarean delivery including postpartum care
59622: Cesarean delivery following attempted vaginal delivery after previous cesarean delivery including postpartum care.
When these CPT® codes are billed on the date of delivery, the provider is paid in advance for the postpartum care. The postpartum visit must occur within 21 to 56 days after the date of delivery. The actual postpartum service, once rendered, must be billed in order to avoid a retraction. To bill the postpartum visit use the CPT® code that was originally billed on the date of the delivery but add modifier TH (i.e., 59410TH, 59515TH, 59614TH, 59622TH). The date of service of the postpartum visit must also be reported when the TH modifier is used. The diagnosis codes on postpartum claims should reflect one of the following: V24.1, V24.2, V25.1, V72.3, and V76.2. This visit is paid at $0 since the postpartum payment was included in the delivery payment.

Annie Posted Wed 23rd of April, 2014 12:15:59 PM

What I was trying to see if Medicare is primary and Medicaid is secondary and the patient has not delivered yet but comes to monthly visits do I bill the Th modifier on each visit. ex. 59425TH

SuperCoder Answered Wed 23rd of April, 2014 18:36:27 PM

I cant confirm because each Medicaid program is different. Medicare does not require the TH modifier and accepts global billing using ACOG/CPT guidelines

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