What's the main strategy used for Obstetrics and Gynecology billing procedures? Is that strategy really preventing you from pitfalls? Quite hard to reveal the obstacles, isn't it? Even though healthcare professionals follow a specific way to prevent revenue loss, most of them don't succeed! CPT codes have changed, ICD-10 has been implemented over a year ago, and it's still not that easy to understand and proceed with the new changes.
Particularly, obstetrics and gynecology billing and coding services have been confronting many challenges, including the risk of more denials and delayed payments. Obstetrics and gynecology billing challenges are unique as it comes with voluminous claims which covers obstetrics and anesthesia for procedures, gynecology, and family planning. In case the practitioner is finding it difficult to handle the voluminous claims, here are some strategies to follow that keep you safe from denials and revenue loss:
A Few Strategies to Avoid Gynecology Billing Denials
One of the best and most important ways to prevent claims from unwanted denials and receive faster reimbursements is to have a better understanding on coding guidelines and updated codes. Healthcare professionals must remain up to date on the codes and guidelines that change frequently and stand as the main cause for errors. Missing the updated codes will greatly affect the obstetrics and gynecology billing practice.
In the past few years, there were many changes made in CPT codes, and it's not so easy to remember them. Having separate volumes for newly arrived codes can make the task much easier than memorizing it. Earlier in 2017, the bull's eye symbol was removed, which indicated that moderate sedation was used for obstetrics and gynecology billing procedures. The same symbol was removed for several CPT codes, as well. They include 10030 (fluid collection drainage by catheter, image guided), 49407 (retroperitoneal or peritoneal, transrectal, or transvaginal), and 57155 (insertion of vaginal ovoids or uterine tandem for clinical brachytherapy). There's a regular CPT code, 58674, which has been added for laparoscopic ablation of fibroids. When healthcare professionals fail to get updated on these codes, it costs the practice. Therefore, it's very important to deal with obstetrics and gynecology billing and coding specialists who are experts in grasping the updates and stay current in their knowledge.
Try to Prevent the Causes for Obstetrics and Gynecology Denials
When you need to stop a problem from getting bigger, it's very apt to find the root cause of the problem and try to not repeat the mistake again. In the same way, if healthcare professionals need to stop their denials from getting larger every day, finding the cause for those denials is essential. One healthcare professional's report revealed some of the most unexpected denials. They are the following:
• 99214: Outpatient doctor visit at level 4
• 99000: A specimen handling office lab
• 81002: Non-automated urinalysis without a scope
• 99213: Outpatient doctor visit at level 3
• 36415: Routine blood capture
Of course, there could be many reasons for denials to occur. Sometimes, healthcare professionals get code 18 denial for duplicate claims, and it's common for claims to get denied for one repeated reason, such as benefits of service already included in the payment for another procedure. Other reasons for claim denials would be because the procedure isn't paid separately, or there are uncovered charges by insurance companies, or errors in documentation or patient information.
Few Tips for Obstetrics and Gynecology ICD-10
Most practices have changes to ICD-10 coding, and even though there are few difficulties, some useful ICD-10 tips to remember can relax your practice during a hectic schedule. Obstetrics and gynecology billing practices should ensure they follow the below tips to keep their work hassle-free:
- Specific trimesters are recommended to be documented. For instance, new ICD-10 CM code 009.01 is for supervision of pregnancy with infertility history within first trimester.
- Healthcare professionals must be aware of the codes that vary depending on particular trimester.
- Pelvic pain and its cause should also be mentioned in the documentation.
- If patient's age causes complications for pregnancy, or if patients are above 35, it's important and necessary to indicate if their age might cause any problem during delivery.
- When the fetus visibility scans are processed, the reason should be documented. It's fair to specify whether it is a routine screening or if there are signs that indicate potential miscarriage.
- Healthcare professionals must document annual gynecology exams. Note that in ICD-10-CM, chapter 21 is changed to chapter 15. The code mentioned for routine gynecology exam is Z01.4.
Obstetrics and Gynecology Billing and Coding Guidelines
Obstetrics and gynecology billing services include maternity services, as well. They include:
- Antepartum care
- Delivery services
- Postpartum care
There are two types of obstetrics and gynecology billing guidelines, which are:
- Global OB care
- Non-Global OB care
CPT codes for Global OB care include the following:
- 59400: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and forceps) and postpartum care
- 59510: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
- 59610: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and forceps) and postpartum care, after previous cesarean delivery
- 59618: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, attempted vaginal delivery after previous cesarean
Keep these strategies and guidelines in mind to prevent revenue loss in gynecology billing.
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