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June 2006 · Vol. 18, No. 6

REIMBURSEMENT ADVISER

Getting paid for pregnancy complications

Melanie  Witt,  RN, CPC-OGS, MA

Independent coding and documentation consultant; former program manager, Department of Coding and Nomenclature, American College of Obstetricians and Gynecologists

Q

A patient was admitted on December 22, at 35 weeks, for a diagnosis of oligohydramnios. The maternal-fetal medicine (MFM) specialist tried unsuccessfully to do an amniocentesis and then decided to induce labor on December 23. The patient delivered on December 24. Our payer is denying all 3 hospital visits as global.

Would it be appropriate to add a –57 modifier (decision to do surgery) to the admission, and if so, what modifier should be added to subsequent hospital visits?

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