Some of the medical billing and coding changes made last year (in 2014) are likely to modify the incomes of OB/GYN clinics in the year of 2015. For example, a decrease in the assigned relative value of units may a reduction in payment for the converted codes. Further, OB/GYN doctors and surgeons are required to document and provide the level of service for all measures of preoperative and postoperative care. Such changes have altered the standards of OB/GYN billing and coding, and thus the processes used by medical clinics who provide such services.
Here are several tips OB/GYN billing and coding for medical procedures specific to OB/GYN:
Learn New OB/GYN Codes & Billing Processes
1. Get familiarized with the new coding updates made by the American Medical Association in the year 2014. AMA has released 335 changes to the Current Procedural Terminology, including several code additions.
Hysterectomy bundling requires including anterior/posterior colpopexy and colporrhaphy procedures into the laparoscopic-assisted and vaginal hysterectomy codes. New codes were added for fetal chromosomal aneuploidy for genomic sequencing, analysis of chromosomes, human papillomavirus low-risk, human papillomavirus high-risk, human papillomavirus types 16 and 18 only, vaccination codes and others. This OB/GYN coding change may be significant affect the payment.
With respect to the latter changes, amongst these changes is a new code for laparoscopy surgical ablation of uterine fibroid(s), including radiofrequency and intraoperative ultrasound guidance and monitoring. These changes in the Current Procedural Terminology and coding updates went into effect on January 1, 2015. Knowing the new coding updates will help OB/GYN clinics to ensure that they can maximize reimbursement and their claims will be unnecessarily denied.
Avoid Common Causes of OB/GYN Billing Denials
2. OB/GYN clinics need to ensure they avoid the common causes of denials. According to statistics, among the top five unexpected denied procedures by Current Procedural Terminology code for the OB/GYN medical specialty are the following:
- 99214: Outpatient doctor visit, level 4
- 99213: Outpatient doctor visit, level 3
- 81002: Urinalysis non-automated without scope
- 99000: Specimen handling office-lab
- 36415: Routine blood capture
These denials have the following top five reasons:
- 18: Duplicate claim/service
- 97: Benefit for service was included already in the payment for another procedure
- 234: Procedure is not paid separately.
- 16: Claim lacks information or has errors
- 96: Non-covered charge(s)
It is because of the common denials why many clinics opt for professional OB/GYN billing services. A highly-specialize OB/GYN billing service, like that of Practice Management can offer a great solution for OB/GYN clinics that are confused with respect to these complicated billing matters.
Adopt a Good System for ICD-10 Billing Claims
3. Good preparation of billing claims for ICD-10 is vital. Among the tips for a better ICD-10 transition in the medical field of OB/GYN field, we can recommend the following:
- Document the cause of pain in pelvic area. In case that the cause of pelvic pain is known and diagnosed, the physicians working in the OB/GYN field should well document this information.
- Document specific trimesters. For example, on the first trimester the supervision of pregnancy with a history of infertility is equated with the ICD-10-CM code O09.01.
- Ensure that you take the most care when documenting the annual gynecological exam. Now the code for an annual GYN exam is changes and instead of chapter 15 as before it is presently included in ICD-10-CM chapter 21. Do not get confused and misuse the Code Z01.4, which denotes just a routine gynecological exam and not the annual gynecological exam.
- It is also recommended to carefully document everything in regards to migraines. For instance, when a patient complains of some chronic migraines related to menstrual cramps specify that the patient has menstrual migraines.
- Also carefully document any reasons for fetus visibility scans. When documenting the fetus visibility scans, it is required to specify if there are any signs indicating a possible miscarriage or it is just a routine screening.
- Specify any possible pregnancy complications related to the patient’s age. For example, in case that a patient is older than 35 years of age, you should indicate if her age may affect delivery.
For more help on how to address these issues and optimize your OB/GYN billing processes, consult with www.MaximizedRevenue.com, a leading medical billing company with a high degree of expertise providing OB/GYN billing services and consulting.