October 18, 2018
Obstetric Billing

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, and Division of Developmental Disabilities
Mercy Care has very specific guidelines on how to bill for obstetric services in our Claims Processing Manual, located on the Claims Information web page on our website.  Mercy Care follows CPT Code Billing Guidelines. 

It's been noted that there have been several situations where Mercy Care has either allowed or denied claims that have not followed our guidelines.  Examples of some of the most common inappropriately billed claims are as follows: 
  • Prenatal services billed along with the delivery are billed with a 21 (inpatient) place of service. Pre-natal services are done in the physician's office and should be billed with an 11 (office) place of service. Billing the Total OB package, along with the E&M codes with a 21 (hospital) place of service will cause the system to deny the entire claim.   
  • Billing $0.00 for the Total OB package will cause the claim to deny. 
  • Prenatal services must be split out on separate lines for each date of service. Providers are not to bill prenatal spanned dates with the number of visits in the units field.  
  • Prenatal visits must be appropriately billed. There is specific coding for broken Total OB packages and the appropriate codes must be used based on the number of visits provided, whether or not the delivery was performed by the same provider. There is also an appropriate delivery only code. 

Effective December 1, 2018, Mercy Care will enforce appropriate provider billing, according to the guidelines in our Claims Processing Manual. We wanted to reiterate the appropriate way to bill these codes in order for you to get your claims paid quickly and accurately without having to resubmit your claim. 

As always, don't hesitate to contact your Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices posted on our website .

Thanks for all you do!