BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire June 2012
OBSTETRICS (OB) CODING
Whether a clinic bills for individual OB visits, delivery and/or postpartum care; or as a prenatal package or global
billing for OB care, the clinic will be reimbursed up to the maximum amount of the appropriate prenatal package or
global billing. As a general guideline, GHC does not reimburse a global OB fee if the patient was a member less
than 4 months prior to delivery. To meet reporting requirements for the Wisconsin BadgerCare Plus and Medicaid
SSI Managed Care Program, it is necessary to collect information regarding the frequency of ongoing prenatal
care. To help achieve this, Providers must submit the dates of individual OB visits, including the CPT and ICD-9
codes, when billing a prenatal package or global billing.
Coding 1st OB or 6-week postpartum visits as a HealthCheck:
If a BadgerCare Plus or Medicaid SSI patient is under age 21 years, the 1st OB or 6-week postpartum visit
may be an ideal opportunity to complete a HealthCheck screen on a patient in this age group. Many of
the required components of a HealthCheck screen are completed as part of these OB visits. (NOTE: Only
one HealthCheck screen per year is allowed for this age group).
The following guidelines address the billing of 1st OB or 6-week postpartum visits as HealthChecks:
1st OB VISIT: Code a 99384-99385 and use V20.2 as the primary diagnosis (ICD-9) code and
V22.2 as the secondary (ICD-9) code.
6-Week Postpartum Visit: If all of the OB care including prenatal care, delivery and postpartum
care were provided, bill the global billing (59400 for vaginal delivery, 59510 for C-section delivery)
using the date of delivery. Then using the date of the 6-week postpartum visit, code the visit at the
appropriate level (99384 /99385). Otherwise, code for the appropriate services provided using the
CPT code for the 6-week postpartum visit.
For Initial Antepartum Care Visits, use appropriate E & M Code(s):
99204 Prenatal Visit – New Patient / 1st Visit
99213 Detailed Prenatal Exam / 2nd Visit – zero charge
For Subsequent Prenatal Office Visits until the patient delivers, use:
99213 Prenatal Visit – Record Zero charge
After the patient delivers, code the appropriate level OB Code or Global Billing:
59425 Prenatal Package (4-6 Prenatal Visits)
59426 Prenatal Package (7 or more visits)
59430 Postpartum Care Only
59409 Vaginal Delivery Only
59410 Vaginal Delivery Including Postpartum Care
59514 Cesarean Delivery Only
59515 Cesarean Delivery Including Postpartum Care
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