Here are three tips for coding and billing common OB/GYN procedures.
1. Know coding updates.
In 2014, the American Medical Association released 335 changes to its Current Procedural Terminology code set. Amongst these changes were code additions. “Category III code 0336T is a new code for laparoscopy, surgical, ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency which has been added to the Medicare ASC List for 2014 with an average Medicare payment of $4,671,” said Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, in a Becker’s ASC Review article.
Keeping abreast of coding updates ensures that claims will not be unnecessarily denied and maximizes reimbursement. The CPT changes for 2015 will go into effect Jan. 1, 2015.
2. Avoid common causes of denials.
Here are the top five unexpected denied procedures by CPT code for OB/GYN in March 2014:
- 99000: Specimen handling office-lab
- 99213: Outpatient doctor visit, level 3
The top five reason codes for these denials are as follows:
- 97: Benefit for service is already included in the payment for another service/procedure already adjudicated
- 18: Duplicate claim/service
- 16: Claim lacks information or has errors
- 234: Procedure is not paid separately.
- 96: Non-covered charge(s)
3. Prepare for ICD-10
Here are some tips for the ICD-10 transition in the OB/GYN field.
- Document specific trimesters. For example, ICD-10-CM code O09.01 is equated with supervision of pregnancy with history of infertility, first trimester.
- Take care when documenting an annual gynecological exam. The code for an annual GYN exam is included in ICD-10-CM chapter 21, not chapter 15. Code Z01.4 denotes a routine GYN exam.
- Document cause of pelvic pain. If cause of pelvic pain is know, OB/GYN physicians should document this information.
