Ob gyn coding and billing is a tough nut to crack. Are you worried that you’re behind the curve? When in doubt turn to the experts. 6 ob gyn medical coding and billing experts share their insights, views and useful tips to help you step up the plate.
We’ve listed out the quotes of 6 leading voices in the ob gyn reimbursement space.
Evaluation and management coding is critical
Effective Evaluation and Management (E/M) coding is critical for the practicing obstetrician-gynecologist. Most problem-based office services have an E/M component and selecting the correct type and level of service can make the difference between success and failure in the operation of a practice. E/M coding is often considered to be confusing and risky, but a clear understanding of E/M coding principles is within reach.
Modifier 25 plays a key role
Medicare would not allow you to bill if that the visit is not supervised at the time of the injection. If the provider performs a significant unrelated E/M, in other words the note is not involved about giving the injection, but it involves some other things if the patient is complaining of that day or something else it need to be evaluated you can bill that other level of E/M service starting with a 99212, if she is established and/or 99201 if she is new patient. And remembering to add a 25 modifier but the note must clearly show it was significant and separate from that injection.
Get the basics right
“When talking to someone about medical bills, get their name, location and a call reference number every time”
ICD-10 coding: Beyond just claim reimbursement
“Getting ICD-10 coding right isn’t just about getting individual claims paid. Proper training also means you’ll upgrade your clinical documentation improvement (CDI) efforts—and your success with MIPs reimbursement. Don’t miss this chance to equip yourself and your team to submit clean Ob-Gyn claims in 2019!”
Use modifiers appropriately
Coding expert Emily Hill, president of consulting company Hill & Associates in Wilmington, N.C., advises all physician offices to include commonly used modifiers on charge tickets to ensure that they are billed.
Follow up, too. Routinely check the actual claims for modifiers. “You might have them on the charge ticket, but the billing staff may or may not be applying them appropriately”
Use carve out codes with caution
“When the provider performs the first OB visit, it is a parallel intake to the GYN preventative. This initial intake (that runs the same extensive HPI (potentially), PFSH, and exam as a WWE) and the pap itself are all included in OB package. You would use your internal “dummy” code for the initial OB visit only.
Please remember that Q0091 is a MEDICARE carve-out only code, and should not be used with any other primary payer.. It gets overlooked in payer’s (specifically Medicaid’s) database, in case Medicaid is secondary to Medicare. If it gets paid, it doesn’t mean it’s right. “
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