Practice Management

  • 1.  Advanced Maternal Age Coding Question

    Posted 03-17-2022 12:48
    Hello..
     I was wondering if someone could assist me or point me to where to find documentation  about the guidelines for billing for Maternal Fetal Medicine for patients with Advanced Maternal Age. The payers are denying the E/M problem visits when billed out with the O09.529 Supervision series as they consider this diagnosis type as global.

    Thank you for your help in advance
    Renee


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    Renee Dixon
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  • 2.  RE: Advanced Maternal Age Coding Question

    Posted 03-18-2022 16:53
    Hi Renee,
    Per CMS rules, this code cannot be the primary diagnosis for inpatient services, including global pregnancy. This makes sense as you would not admit a patient primarily or only because she is AMA. You should not have problems using it for outpatient services, including ultrasound, if used per established clinical guidelines. Please reply if you are getting denials when using this code for outpatient services.
    Fadi

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    Fadi BSAT, MD, FAIUM
    Past Chair, SMFM Coding Committee
    Chair, SMFM Practice Management Division
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  • 3.  RE: Advanced Maternal Age Coding Question

    Posted 03-18-2022 17:04
    Hello Fadi,

    Thank you for information....Yes, I am referring to the outpatient visits and ultrasounds.....We have always used these codes in the past for outpatient with no problem but as of late Cigna is denying the (O09) CPT series as global as well as Blue Cross and scattering denials with other insurances. 

    Thank you,
    Renee

    With Appreciation,
    Renee S. Dixon, CPC
    Office 561-275-7625 *Fax 561-820-2911
    770 North Point Parkway Suite 102
    West Palm Beach, Fl. 33407



    CONFIDENTIALITY NOTICE: The information contained in this transmission may be privileged and confidential, as it is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this transmission in error, please immediately reply to the sender that you have received this communication in error and then delete it. Thank you.







  • 4.  RE: Advanced Maternal Age Coding Question

    Posted 03-18-2022 17:19
    Hi Renee,

    A few years ago, Cigna advised me that supervision codes would be denied as global. Mid-2020, they began denying most of claims as global. It took several claims projects to get them to understand that their global policy does not apply to our MFM contract. It is actually a Cigna system issue. After getting the AZ Department of Insurance involved, they implemented a system for our tax ID to have the denials reviewed and reprocessed. I am started to see less global denials from Cigna, but they only paid interest on a few claims.

    The practice manager will need to contact someone in claims to accept a project and have this issue resolved.

    Kind regards,
    Heather Hall


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    Heather Hall
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  • 5.  RE: Advanced Maternal Age Coding Question

    Posted 03-18-2022 17:35
    Hi Heather,

    Thank you so much for information...this is very helpful...I will do just that.
    Renee

    With Appreciation,
    Renee S. Dixon, CPC
    Office 561-275-7625 *Fax 561-820-2911
    770 North Point Parkway Suite 102
    West Palm Beach, Fl. 33407





    CONFIDENTIALITY NOTICE: The information contained in this transmission may be privileged and confidential, as it is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this transmission in error, please immediately reply to the sender that you have received this communication in error and then delete it. Thank you.