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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.