Alerts

ICD-10 Diagnosis Codes that Identify Trimester and Gestational Age AND Birth Weight Requirement on UB-04 Claim Forms

12/14/2016

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TO: 
Hospitals, OB/GYNs, Nurse Midwives, Maternity Primary Contractors, FQHCs and RHCs

Effective for Dates of Service beginning January 1, 2017 and thereafter, Medicaid will require ICD-10 codes that identify the estimated weeks of gestation and trimester on a UB-04 or CMS 1500 claim form submitted for a pregnant recipient when the recipient has received any prenatal, delivery or postpartum services. The gestational age and trimester will be required on the mother’s claim, not the newborn’s claim. The Gestational Age Diagnosis codes are Z3A.00 through Z3A.42. Additionally, Medicaid will require the birth weight on all applicable UB-04 claim forms associated with a delivery.


ICD-10 Diagnosis Codes that Identify Trimester and Gestational Age


Gestational age diagnosis codes must be on the claim when one of the following 3 criteria are met:

1.    A Professional and Outpatient Hospital claim is billed with the following delivery codes

           (CMS 1500 or OP UB-04 claim form): 

 

59400-59410

Vaginal delivery

59510-59515

Cesarean delivery

59610-59622

Delivery after previous cesarean delivery

 

2.    A Professional claim (CMS 1500 claim form) is billed with a pregnancy diagnosis code

     and procedure code listed below by a Nurse Midwife or Physicians with the specialties 316

    (Family Practitioner), 318 (General Practitioner), 328 (OB-GYN): 

 

Pregnancy Diagnosis Codes:

 

Z33

Pregnant state

Z34

Encounter for supervision of normal pregnancy

Z32.01

Encounter for pregnancy test-positive

O00-O08

Pregnancy with abortive outcome

O09-O09

Supervision of high risk pregnancy

O20-O29

Other maternal disorders predominantly related to pregnancy

O30-O48

Maternal care related to the fetus and amniotic cavity and possible delivery problems

 

Evaluation and Management (E&M) Procedure Codes:

 

99201-99205

New Patent Office Visits

99211-99215

Established Patient Office Visits


3.    When an Institutional Claim (UB-04 claim form) is billed with any of the following ICD-10

      procedure codes:  

 

10D00Z0-10D0728

Cesarean Delivery

10E0XZZ

Vaginal Delivery



Birth Weight Requirement on Institutional Inpatient UB-04 Claim Forms


Entering the Newborn’s Birth Weight on the Newborn Inpatient Facility Claim:

 

Please follow these guidelines for inpatient delivery claims

                                                                                                                  

·         For paper claims, enter value code 54 in box 39, 40 or 41 and the newborn’s birth weight (in grams) in the corresponding amount field.

·         For electronic claims, enter the newborn’s birth weight in loop 2300, segment HI, with the qualifier BE and the value code 54 in HI01-2 and the newborn’s weight (in grams) in HI01-5.

 

*Please note that the newborn birth weight
must be entered in the format of xxxx.xx.

 

UB-04 Claims with the following criteria will require birthweight in the value code:

 

A Claim submitted with one of the following ICD-10 Surgical Procedure:

10D00Z0-10D0728

Cesarean Delivery

10E0XZZ

Vaginal Delivery

 

A Claim submitted with one of the following ICD-10 Diagnosis Codes:

O68-O709

Deliveries with Complication

O80-O82

Encounter for Delivery

 

If you have any questions about this ALERT, please contact the appropriate program area contact listed below: 

 

Maternity Program:  Sylisa Lee-Jackson at Sylisa.Lee-Jackson@medicaid.alabama.gov

Physician Program:  Beverly Churchwell at Beverly.Churchwell@medicaid.alabama.gov

Hospital Program:  Solomon Williams at Solomon.Williams@medicaid.alabama.gov

FQHC and RHC Program:  Karen Watkins-Smith at Karen.Watkins-Smith@medicaid.alabama.gov


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2016 American Medical Association and © 2016 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.