For Dates of Service Before October 1, 2015

Diagnosis Codes on Claims for Prenatal Care Coordination Services

Claims submitted for PNCC services must include either diagnosis code V22.2 (pregnant state, incidental) or V23.9 (unspecified high-risk pregnancy).

Providers are required to indicate the following diagnosis codes on claims for PNCC services:

• V22.2 when submitting a claim on behalf of a member who does not meet the enrollment criteria (i.e., those who are assessed but determined ineligible to receive services). Diagnosis code V22.2 may only be used with procedure code H1000.
• V23.9 when submitting a claim on behalf of a member who scores four or more points on the Pregnancy Questionnaire or is under 18 years of age (i.e., those who are determined eligible to receive services).
• V23.9 when submitting claims with procedure codes H1000, H1002 and modifier "U2," H1003, H1003 and modifier "TT," H1004, and T1016 and modifier "TH."

ForwardHealth will deny claims if providers indicate other diagnosis codes when submitting claims for PNCC services.