Use appropriate modifier when billing high-risk and non-obstetric conditions for maternity patients

Our system is currently being updated to allow you to enter an evaluation and management procedure code with modifier 25 when billing for maternity patient visits for high-risk conditions or conditions unrelated to the pregnancy during the 270-day antepartum period.

The diagnosis code and documentation should support the patient’s high-risk condition or other condition unrelated to the pregnancy for the purposes of post-audit review.

If you receive a claim rejection before our system update is complete, you may request reconsideration of services rendered by sending documentation to be reviewed through the appeals process.

For uncomplicated maternity cases, global maternity codes are used to indicate antepartum care, delivery and postpartum care. Generally, E&M codes are not used during the prenatal period, since global maternity codes include E&M components.