Tricks of the Trade / Things to Know About OB/GYN Billing

Posted by Team PracticeForces on Jun 20 2016

Things to Know About OB/GYN BillingFrom pregnancy, delivery, and beyond, the OB GYN practice is dedicated to caring for women at every stage of life. Obstetrics and gynecology focus on the two medically separate states of pregnancy and nonpregnancy, and these two states can be combined in a surgical-medical specialty that allows them to care for their patients before, during, and after pregnancy.

An OB GYN practice treats and performs a broad range of conditions and procedures. Attention to detail and understanding of the changing medical billing requirements is necessary to ensure prompt and effective reimbursement for services.

Familiarize Your Team With New OB/GYN Medical Billing Requirements

The key to successfully being reimbursed for services is to ensure that your medical billing company is up to date on all new coding updates. Coding requirements change regularly and coding errors can result in loss of revenue and payment delays. Verifying and understanding the OB/GYN coding can ensure prompt reimbursement payments.

For OB/GYN clinics, there are a handful of common denials that your practice can avoid. According to statistics from the Current Procedural Terminology code, the most common coding mistakes are as follows:

  • 36415: Routine blood capture
  • 81002: Urinalysis non-automated without scope
  • 99000: Specimen handling office-lab
  • 99213: Outpatient doctor visit, level 3
  • 99214: Outpatient doctor visit, level 4

And why are these commonly denied? The reasons provided for the denials are listed below:

  • 16: Claim lacks information or has errors
  • 18: Duplicate claim/service
  • 96: Non-covered charge(s)
  • 97: Benefit for service was included already in the payment for another procedure
  • 234: Procedure is not paid separately.

Denials for these or any reason can seriously delay reimbursement for services rendered and in some cases reduce the overall payment amount. Outsourcing services for OB/GYN medical billing by a highly qualified and experienced company can help ensure these types of denials are avoided and reimbursement is obtained quickly and easily.

Understanding the Transition for ICD-10 OB/GYN Medical Billing Claims

There are a number of things that an OB GYN practice can do to prepare their billing claims in the transition to ICD-10 that can improve payment, report their services more effectively, and receive prompt reimbursement.

Specify trimester appropriately: The ICD-10-CM Manual requires the reporting of the specific trimester of the patient. The physician can choose to list the trimester specifically or simply denote the number of weeks and days of pregnancy, so the coder can calculate the trimester before submission. Submitting unspecified trimester can reflect poorly on the physician and their attention to detail in their patient care.

Annotate annual gynecological exam: Physicians are responsible for documenting annual exams for their patients, and specifying the type of test and the appropriate ICD-10 code. For ICD-10-CM, the code for the annual GYN exam is included in Chapter 21, as opposed to Chapter 15. Take the time to verify the specifics of the exam and annotate it as such, including whether abnormal findings were or were not present, as this can affect the code assignment for the service. While a physician can bill an E/M code for the visit, the cervical smear test must be billed by the lab only.

Document Pain In The Pelvic Area: If the physician is able to determine the cause of the pelvic or abdominal pain associated with menstruation, the diagnosis should be clearly documented in the patient portfolio. By specifying the cause of the pain – adhesions, cystic ovaries, menorrhagia, or others – the coders can ensure they capture the correct coding requirements for your patient.

Specify Any Reasons For A Fetus Visibility Scan: If the scan was performed as a routine screening or whether it was to see if there were any signs indicating a possible miscarriage needs to be specified to ensure the proper coding

Don’t Ignore Migraine Concerns: Carefully document your patient’s experience with migraines, especially when associated with their cycles.

Consider Advanced Maternal Age: If your patient is pregnant and is over 35 years of age, she may be considered advanced maternal age. Specify this in your documentation, and also what specific problems might be experienced.

By ensuring your paperwork for each patient is as accurate and thorough as possible, your medical billing company will be able to ensure the proper code assignment to each visit. Proper coding the first time paperwork is submitted can ensure prompt payment as well as the best patient experience.


Request a Consulation

Topics: OB/GYN billing, OB/GYN medical billing

Subscribe to Email Updates

Recent Posts

Posts by Topic

see all