Be Compliant with Accurate OB/GYN Coding Guidelines

2. 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. It’s 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. It’s 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. Don’t forget to use separate E/M codes when appropriate. You can use these codes for services that aren’t related to maternity care. Use modifiers to adjust your codes when you’ve altered the services outlined in the original CPT code.

3. Be Compliant with Accurate OB/GYN Coding Guidelines Know your payers: Make sure you understand the payer’s 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 payer’s 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 practice’s bottom line. Check patient eligibility and estimates: Watch out for OB patients with high deductibles. Hold off on billing your claim until the hospital’s 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. They’ll 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 patient’s agreement

4. 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 payer’s guidelines. Hysterectomy 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

5. Be Compliant with Accurate OB/GYN Coding Guidelines 58291. Laparoscopic hysterectomy codes range between CPT codes 58541 to 58573. Well-woman visits It’s important to remember that you’ll 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 you’ve 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@medicalbillersandcoders.com or call us at: 888-357-3226.