Billing and coding for Obstetrics/Gynecology is a complex task and coding missteps can be costly. Picking the right diagnostic code for claims from insurance payers can go a long way in increasing your reimbursements. Hence, Ob/Gyn coding must be done by experts who are aware of components comprised in the global surgical package (as per CPT and Medicare), are capable of affixing the appropriate CPT modifiers, and are skilled at detailing of repeat PAP smear payments, etc.
As per guidelines, a description of procedures and why they were performed coupled with appropriate coding is imperative; and these must be supported by apt documentation for preoperative and postoperative care.
Some Ob/Gyn coding rules are:
It is vital for coders to be updated with the latest changes that keep occurring in the Ob/Gyn coding arena to increase reimbursements and decrease denials; for e.g. CPT code changes that have occurred in fetal chromosomal aneuploidy for genomic sequencing, human papillomavirus (low/high risk), laparoscopy surgical ablation of uterine fibroid(s), vaccinations, etc. Also, the coders must be aware of common denials and their causes as to not repeat in the future.
2. Pelvic area:
The Ob/Gyn coder must document the cause(s) of pain in the pelvic/abdominal area and this must be documented by the physician appropriately. The coder must also specify if the menstrual migraine (ICD-10-CM codes G43.82- and G43.83-) is intractable vs. not intractable and is with or without status migrainosus.
3. Pregnancy trimesters:
Each trimester must be documented separately or the physician can document the number of days or weeks separately. For eg., the First trimester (if monitored) for those with a history of infertility is coded in ICD-10-CM as O09.01 and O60.02 indicate preterm labor with no delivery in the second trimester. Also, trimesters must be included in the obstetrics code too. Extensions must be added to specify the fetus.
4. Annual gynecological examination:
Take utmost care for coding a routine gynecological exam vis-a-vis an annual gynecological exam. Per ICD-10-CM, the annual exam is located in chapter 21, and Code Z01.4 denotes a routine exam. The physician must also specify if there have been any abnormal findings. ICD-10-CM code can be billed with an E/M code for this visit, but the cervical test smear test can be billed by the lab.
Carefully document the weight, height and blood pressure of the patient. This is usually considered a part of the examination unless it is a review of information that is then used to document the portion of history that entails the review of systems (ROS).
Document carefully here as chronic migraines related to menstrual cramps is actually documented as menstrual migraines.
7. Physician’s decision:
With regards to the E/M visit, the Ob/Gyn billers and coders must work with the physician to decide the E/M code and the corresponding ICD-10 codes for the services and procedures he has rendered to the patient.
8. Fetus visibility scans:
Document the reasons for the same and specify if it is a miscarriage (decreased fetal movement or fetal anemia and thrombocytopenia) or routine screening.
In pregnancy, complications are common. The age (over 35yrs.) of the patient must be specified and associated to complications in her delivery, if applicable. For e.g., during delivery, if patients have pre/post eclampsia, there is an increased probability of postpartum hemorrhage or growth by the accumulation of placenta. However, during the antepartum care, there could be increased chances of genetic risk factors for abnormalities of the fetus.
10. Avoid confusion:
The Ob/Gyn billers and coders must not confuse the word ‘referral’ with ‘consultation’ as the word ‘referral’ implies that there has been a transfer of care from one physician to the other.
Ob/Gyn billing companies are an efficient way that caters to numerous specialties for their revenue cycle management in the medical fields including Ob/Gyn. As this specialty deals with voluminous claim filings, they are adept at dealing with all sorts of issues such as maternal-fetal medicine, gynecological urogynecology, and pelvic reconstructive surgery, menopausal and geriatric gynecology, family planning claims, etc. The billing companies keep the payment cycle to a maximum of 25 days. Their team is well versed with HCPCS codes such as J2675, G0101, Q0091 and CPT code 59514 and the complicated services and reimbursements associated to these. With increased medical cases, competition, and billing and coding regimens, there is hardly any reason that you should not choose this team for all your Ob/Gyn billing and coding needs.