Be Compliant with Accurate OB/GYN Coding Guidelines

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Be Compliant with Accurate OB/GYN Coding
Guidelines
Many times physicians tends to code a regular set
of procedure codes without a proper understanding
of coding guidelines. Its always advisable to
take the guidance of certified coders who have a
deep understanding of payer-specific and medical
specialty-specific coding guidelines. Otherwise
consistent inaccurate medical coding might result
into an external payer audit. Its specifically
true for Obstetrics and Gynaecology (OB/GYN) as
maternity care services include antepartum care,
delivery services, as well as postpartum care. In
this article, we mentioned accurate OB/GYN coding
guidelines which would be helpful in staying
compliant with payer guidelines. Accurate OB/GYN
Coding Guidelines Know your global codes vs. E/M
codes Use global codes for maternity care.
Avoid billing separately for services already
included in these codes. Dont forget to use
separate E/M codes when appropriate. You can use
these codes for services that arent related to
maternity care. Use modifiers to adjust your
codes when youve altered the services outlined
in the original CPT code.
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Be Compliant with Accurate OB/GYN Coding
Guidelines
Know your payers Make sure you understand the
payers billing guidelines for deliveries and
antepartum care. Some plans, such as Medicaid HMO
plans, require you to bill for deliveries with
non-standard codes. Know payer-specific rules for
what you can bill outside of the global fee. Each
payer has different parameters for the procedures
and services you can bill for on top of the
global care code. For example, the payer may
reimburse for ultrasounds outside of the global
fee. Check each payers guidelines for initial OB
(IOB) visits. Knowing when to start billing a
global fee and when to bill for separate services
could make a big difference in your practices
bottom line. Check patient eligibility and
estimates Watch out for OB patients with high
deductibles. Hold off on billing your claim until
the hospitals claim hits insurance, so the
hospital can absorb the deductible on their
claim. Create an OB contract for patients to
pay their portion of the delivery claim before
delivery. Patients will have a lot of medical
bills from the delivery experience. Theyll have
a better sense of security and overall experience
with price transparency, up-front estimates and
the option to make payments before delivery.
Create a workflow for advance beneficiary notice
(ABN) forms. This is a document for Medicare
patients. It outlines the patients agreement
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Be Compliant with Accurate OB/GYN Coding
Guidelines
to pay for the procedure or service if Medicare
does not cover it. Global codes You can use
global codes when the same physician or physician
group provides all maternity services for a
patient. OB global codes include 59400, 59510,
59610 and 59618. These include all care from
antepartum through delivery and postpartum care.
Antepartum care includes the care provided from
conception up to delivery. Intra-partum care
includes care provided during delivery.
Postpartum care includes care provided after
delivery this period starts after the patient
leaves the hospital and continues for 42 to 84
days, based on the payers guidelines. Hysterecto
my coding The approach to the surgery will
determine the CPT code. There are three main
approaches abdominal, vaginal and laparoscopic.
The weight of the uterus will also influence
which CPT code you should use. The extent of the
surgery (how much of the uterus is removed) will
influence which CPT code you should use. Some CPT
codes factor in additional services done with the
hysterectomy. Abdominal hysterectomy codes range
between CPT codes 58150 to 58210. Vaginal
hysterectomy codes range between CPT codes 58260
to
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Be Compliant with Accurate OB/GYN Coding
Guidelines
58291. Laparoscopic hysterectomy codes range
between CPT codes 58541 to 58573. Well-woman
visits Its important to remember that youll
code well-woman exams based on two factors The
age of the patient and whether they are a new or
returning patient. New patient codes range from
99385-99387 and existing patient codes range from
99395-99397. Modifiers OB/GYN CPT codes often
include modifiers on the end. Modifiers are
two-digit codes that show youve somehow altered
the service in the original five-digit CPT code.
Some common modifiers you might use in OB/GYN
codes include modifier-25, modifier-51,
modifier-57, modifier-59, modifier-78, and
modifier-79. Medical Billers and Coders (MBC) is
a leading medical billing company providing
complete medical billing services. Our certified
coders follow accurate OB/GYN coding guidelines
to ensure an accurate selection of procedure
codes along with modifiers. To know more about
our OB/GYN billing and coding services, contact
us directly at info_at_medicalbillersandcoders.com or
call us at 888-357-3226.