Avoiding Claims Denials for OB/GYN

Denials are a thorn in the flesh for most medical practices. But there are some specialties that have an exceptionally high denial rate. OB/GYN is, unfortunately, one of them. Denial rates in this specialty are the highest at a whopping 22.42%. Denials are an everyday occurrence for most OB/GYN centers. OB/GYN billing and coding comes with unique challenges because of the voluminous claims filing that comes with a practice that covers Obstetrics, Anesthesia for the procedure, Gynecology, and Family Planning. If your practice is dealing with excessive claims denials that are hurting revenue, here’s a look at several strategies you can use to avoid claims denials OB/GYN and start improving revenue for your practice.

Most Common Causes for Claims Denials for OB/GYN

There are so many facets to appealing a denied claim. While each denial may seem the same, each one is definitely unique. The first thing one should do when a claim is denied is to review the EOB and determine why it was denied. It helps to be aware of some of the most common causes of OB/GYN denials so you can avoid them.  In most cases, you will get a code 18 denial for a duplicate claim or service, while it’s often common that the claims are denied because the benefit for service was already included in the payment of another procedure or service. These claims may be denied because the procedure isn’t paid for separately, the charge isn’t covered by the payer, or it could just be that the claim has errors or lacks essential information required for reimbursement.

Keep a Close Eye on Coding Updates

One of the best ways to make sure claims aren’t unnecessarily denied so you can maximize reimbursements is to stay well informed on coding updates that affect OB/GYN practices. Within the past few years, several changes in CPT codes have been made, so it’s important to stay up-to-date. Failing to be updated on current coding updates has the ability to cost your practice thousands of dollars, which is why it’s so important to work with billing and coding specialists that are current in their knowledge. With the new 2019 ICD-10-CM code set now available, more than 30 of the changes apply to OB/GYN. These changes include updating coding multiple gestation pregnancies to coding for obstetric surgical wound infections.

Follow Best Practices for OB/GYN Coding

  • Specific trimesters need to be documented. For example, using the new ICD-10-CM code O09.01 is for the supervision of a pregnancy with an infertility history within the first trimester. Be aware that codes may vary depending on the specific trimester.
  • The cause of pelvic pain needs to be documented if it is known.
  • If a patient’s age is complicating a pregnancy. For example, patients over 35 years old, indicate whether their age may affect their delivery.
  • If fetus visibility scans are done, document the reason. Specify whether it’s simply a routine screening or there have been signs that may indicate a potential miscarriage.
  • Be careful when documenting annual gynecological exams, since the annual GYN exam code is in ICD-10-CM chapter 21 instead of in chapter 15 where you may expect it. The code for a routine GYN exam is Z01.4.

Outsource to avoid Claims Denials for OB/GYN

Even small errors can end up causing Claims Denials for OB/GYN, and with all the voluminous claims filing that comes with OB/GYN billing and coding, it could be a good option for your practice to outsource your billing and coding. OBGYN coding is already difficult, and these new changes to the ICD-10 codes for 2019 only add to coding difficulties for your practice.

Simply forgetting to add additional characters to codes that specify a type of surgical wound is enough to get your claim denied, and denials can cost your practice big time. Through outsourcing, many OBGYN practices are able to improve billing and coding efficiency so they’re able to spend more time focusing on offering patients quality patient care. Medical Billers and Coders is a reputable medical billing and coding company that offers the highest quality service for clients across the country. To learn more about how we can end your OB/GYN billing and coding difficulties, contact us today.

It is critical to follow the appeals process laid out by the payor. Never assume payor appeals processes are identical. Mark the dates for deadlines and plan on sending appeals 4 -5 days before a deadline. Repeat this for each level of appeal. A winning appeal always involves solid payor policy research, supplying complete medical records (with Orders, Lab Results, X-ray Reports, the works, to ensure medical necessity), and crafting a well-written appeal letter addressing the denial reasons while providing strong details of support from the documentation.