What’s the main strategy used for Obstetrics and Gynaecology 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, yet most of them don’t succeed! CPT codes have changed and ICD-10 has been implemented an year ago, it’s not that easy to understand and proceed with the new changes.

Especially obstetrics and gynaecology billing and coding services have been confronting many challenges including the risk of more denials and delayed payments. Obstetrics and gynaecology billing challenges are unique as it comes with voluminous claims which covers obstetrics and anesthesia for procedure, gynaecology and family planning. In case if the practitioner is finding it difficult to handle the voluminous claims, here are some strategies to follow that keeps you safe from denials and revenue loss.

Few strategies to avoid gynaecology 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 ensure to keep updating the codes and guidelines that changes frequently and stands as the main cause for errors. Missing the updated codes will definitely affect obstetrics and gynaecology billing practice.
  • In the past few years there were many changes made in CPT codes and it’s not so easy to recollect and change them from the mind. Having separate volumes for newly arrived codes can make the task much easier than memorizing it.
  • Earlier in 2017, bull’s eye symbol was removed and which actually indicates the moderate sedation used for obstetrics and gynaecology 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), 57155(insertion of vaginal oviods or uterine tandem for clinical brachytherapy).
  • There’s a regular CPT code 58674 which has been added for laparoscopic abration of fibroids. When healthcare professionals fail to get updated on these codes, it means that it costs a lot for the practice.
  • So, it’s very important to deal with obstetrics and gynaecology billing and coding specialists who are experts in grasping the updates and stays current in their knowledge.

Try to prevent the causes for obstetrics and gynaecology denials:

  • When you have 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 has to stop their denials getting larger day by day, finding the cause for those denials is very essential.
  • One of the healthcare professional’s report revealed some of the most unexpected denials. They are:
  1. 99214: Outpatient doctor visit at level 4.
  2. 99000: A specimen handling office lab
  3. 81002: Non-automated urinalysis without a scope
  4. 99213: Outpatient doctor visit at level 3
  5. 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 always common for the claims to get denied for one repeated reason, benefits of service already included in the payment for another procedure.
  • Another reason for claim denials would be because the procedure isn’t paid separately, uncovered charges by insurance companies, errors in documentation and patient information.

Few tips for Obstetrics and Gynaecology ICD-10:

  • Most of the practices have changes to ICD-10 coding even though there are few difficulties, but some useful ICD-10 tips to remember can relax your practice during hectic schedule.
  • Obstetrics and Gynaecology billing practices must ensure to follow the below tips to keep their work hassle free.
  • Specific trimesters are recommend 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 those actually vary depending on particular trimester.
  • Pelvic pain and its cause should also be mentioned in the documentation.
  • In case 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 routine screening or there are signs that indicate potential miscarriages.
  • Healthcare professionals must ensure to document annual Gynaecology exams as the chapter 21 is changed to chapter 15 in ICD-10 coding. The code mentioned for routine Gynaecology exam is Z01.4.

Obstetrics and Gynaecology billing and Coding Guidelines:

  • Obstetrics and Gynaecology billing services include maternity services as well. They would be :
  1. Antepartum care
  2. Delivery services
  3. Postpartum care
  • There are two types of obstetrics and Gynaecology billing guidelines, they are:
  1. Global OB care
  2. Non Global OB care
  • CPT codes for Global OB care include:
  1. 59400: Routine obstetric care including antepartum care, vaginal delivery(with or without episiotemy and forceps)and postpartum care .
  2. 59510: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care.
  3. 59610: Routine obstetric care including antepartum care, vaginal delivery(with or without episiotomy, and forceps)and postpartum care, after previous cesarean delivery .
  4. 59618: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, attempted vaginal delivery after previous Cesarean.

Hope you got the information on Obstetrics and Gynaecology billing. For more suggestions, please comment below, we will definitely consider them if relevant. For more queries and updates on healthcare, please subscribe to our blog.

Strategies to prevent revenue loss in Gynaecology Billing!