One of the most challenging areas for coders in medical coding and billing companies is the obstetrics and gynecology medical billing and coding. Effective from October 1, 2016, the guideline for “Prenatal outpatient visits for high-risk patients” has been replaced with the title of “Supervision of High-Risk Pregnancy.” many OB-GYN Medical Billing practices have faced difficulties that have increased claims denials and slowed the practice revenue cycle.
The global obstetric code should be billed whenever one practitioner or practitioners of the same group provide all components of the patient’s obstetrical care, including; 4 or more antepartum visits, delivery, and postpartum care.
The number of antepartum visits may vary from patient to patient, however, if global OB care includes more than 3 antepartum visits, delivery, and postpartum care is provided; ALL pregnancy-related visits excluding inpatient hospital visits for complications of pregnancy should be billed under the global OB code. Individual E/M codes should NOT be billed to report pregnancy-related E/M visits.
OB-GYN Medical Billing Challenges Arise From Childbirth Complications Are:
Recognizing The CPT Package Codes
For complications during childbirth, the trimester during which the complication occurs is part of the code selection in ICD-10-CM and the trimester should be documented. The number of weeks the patient is pregnant will determine the code selection.
In ICD-10-CM, there is no longer the fifth digit classification for an episode of care that is used in ICD-9-CM. The trimester is included as part of the complete code description.
Complications In Pregnancy Trimester
For complications of pregnancy, the trimester during which the complication occurs requires the part of the code selection in ICD-10-CM and the trimester should be documented. At times it has happened that the medical staff at the hospital forgets to mention the same. The number of weeks the patient is pregnant will determine the code selection.
In ICD-10-CM, there is no longer the fifth digit classification for an episode of care that is used in ICD-9-CM. The trimester is included as part of the complete code description. Hence; medical billing companies find it challenging when the coding is not documented and there’s a repeat process of follow-up and it ends up in more complications when it should be cleared in one go.
Gestational Diabetes Codes
Gestational diabetes codes in ICD-10-CM have a considerably different structure than that of the pre-existing or unspecified DM in pregnancy codes. Gestational diabetes is subdivided into codes that specify whether it is diet-controlled, insulin-controlled, or unspecified control in pregnancy.
As there happens the medical staff being unqualified or not trained loses out to mention the codes while billing; therefore making it more complicated for the OB-GYN medical billing. This becomes challenging as it is important to know which exact codes need to be documented.
Genetic Disorders
In ICD-9-CM, diabetes mellitus complicating pregnancy, childbirth, or the puerperium is reported with 648.0x. Other pre-existing DM O24.8- is used when the patient had either DM due to another underlying condition, such as Cushing’s syndrome; drug or chemical induced DM; DM due to genetic disorders/defects; or other secondary DM prior to pregnancy.
Additional codes reported with O24.8- for the particular diabetic manifestations must be selected from the category in the endocrine chapter that reflects the appropriate type of other pre-existing diabetes. These will be from categories E08, E09, or E13. In both classification systems, a code for long-term use of insulin needs to be provided to avoid your billing going mess.
Final Thoughts
To ensure that the childbirths are healthy and that they can carry their infant or infants to term, women with high-risk pregnancies and other childbirth complications should receive care from a special team of OB-GYN medical billing services providers.
By opting to outsource billing services is a practical strategy for obstetrics and gynecology specialists. With an experienced team of certified coders and OB-GYN medical billing professionals handling your coding and claim submission for appropriate reimbursement, these providers can focus on what they do best – offering optimum care that their patients need.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle management services. To know more about our OB-GYN medical billing and coding services, contact us at info@medicalbillersandcoders.com/888-357-3226.
FAQs:
1. What changes were made to the guidelines for high-risk pregnancy care?
As of October 1, 2016, “Prenatal outpatient visits for high-risk patients” was replaced with “Supervision of High-Risk Pregnancy,” impacting how claims are processed.
2. When should a global obstetric code be billed?
A global OB code should be billed when one practitioner provides all components of care, including at least four antepartum visits, delivery, and postpartum care.
3. How do trimester complications affect coding?
The trimester during which a complication occurs is crucial for selecting the correct ICD-10-CM code, and it must be documented accurately to avoid billing issues.
4. What challenges arise with gestational diabetes coding?
Gestational diabetes codes differ significantly from other diabetes codes, and it’s essential to specify whether it’s diet-controlled or insulin-controlled to ensure accurate billing.
5. How can outsourcing billing help OB-GYN practices?
Outsourcing to experienced medical billing services, like Medical Billers and Coders (MBC), allows OB-GYN specialists to focus on patient care while ensuring accurate coding and timely reimbursement.
