Wrapping Up this Series!
SPLIT BILLING FOR AETNA
Physicians who provide some but not all prenatal care and delivery should bill for the portion of prenatal care according to the following CPT instructions:
- 59425: 4-6 prenatal visits
- 59426: 7+ visits
- Use standard E&M codes for fewer than four prenatal visits
- 59409: vaginal delivery only
- 59410: vaginal delivery and postpartum care
- 59514: cesarean delivery only
- 59515: cesarean delivery and postpartum care
- 59614: vaginal birth after cesarean delivery and postpartum care
- 59612: vaginal birth after cesarean delivery only
High-risk Pregnancy Management Enhancement
Aetna pays an additional fee to the obstetric care provider for managing a high-risk pregnancy.
This applies to all products when the following are true:
- The member is enrolled in the Beginning Right maternity program, if available.
- Risk factors are identified.
- There’s an increase in the intensity and/or frequency of care throughout the pregnancy.
- Modifier 22 is added to the global obstetric fee claim
THINGS TO REMEMBER:
- You will be reimbursed in addition to the global obstetric fee, when visiting an Aetna member during an antepartum inpatient stay.
- Lab studies (CPT 85013, 85018, 82947, 82948, 82962) performed in the OB office will be reimbursed outside of the global obstetric fee.
Resources & Credits:
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