Susan Posted Mon 20th of June, 2016 17:59:40 PM
At first ob visit patient noted she was recently diagnosed with thyroid CA and was to have surgery. OB doc consulted with surgeon and recommended waiting until after 12 wks. During this time and immediately after surgery she had more visits than normal to monitor fetal viability. At the end of pregnancy she had total of 18 visits. Can I bill extra visits or add -22 modifier for malig neoplasm complicating pregnancy, even though by delivery she no longer had the condition? Per the notes it's hard to tell which visits were actually the extra ones. Not sure how to bill this so that physician is compensated for the extra care.
SuperCoder Answered Tue 21st of June, 2016 03:43:33 AM
If your physician has performed prenatal visits only, then you should report CPT code 59426 for more than 7 visits and if your provider has seen the patient more than the limit (please check with payer), due to complications of the pregnancy (e.g. thyroid CA in this case), you should add a modifier 22 (Increased Procedural Services) and send documentation of each visit to your payer. Some payers pay per visit beyond the limited number of visits. Please confirm payment policy in such case with the payer.
Moreover if your physician has performed all the 3 i.e. antepartum care, delivery, and postpartum care, then you should report a global code from the following:
1) 59400 or 59610 – for vaginal delivery
2) 59510 or 59618 – for Cesarean delivery
Modifier 22 usage will be same as explained above.