Know the aspects of obstetrics gynecology medical billing services

Know the Aspects of Obstetrics Gynecology Medical Billing Services Obstetrics and gynecology are two distinct specialties which deal with the female reproductive organs, where one deals with treating women in a pregnant state, while the other does not. However, the OB/GYN physician typically treats and conducts procedures on a woman before, during, and after her pregnancy. As these are technically two specialties, the billers and coders in this field must be very knowledgeable (education and experience) about the billing of procedures, devices, medicines, injectable, which takes place together as a package for these two fields and/or are billed separately. Some Tips on OB/GYN billing: Codes: For unnecessary claim denials to not amass, gain full reimbursements, and not create an disruption in the cash flows for the services tendered by the physician, it is the responsibility of the billers and coding to be well aware of the 'Well Woman Exam' coding. As insurance agencies reimburse on different guidelines, the biller must identify which ones will pay when a G0101 (Cervical or Vaginal cancer screening), Q0091 (Screening papanicolaou smear), S0610 (New patient-annual gynecological exam), or S0612 (Established patient – annual gynecological exam) is submitted as few insurances pay for a specific code, while some reimburse for a grouping of codes. Again, some payers pay when the claims are submitted with a preventive visit (9938*-9939* codes), while others require an office visit (9920*-9921* codes). The biller must have an understanding of the diagnosis codes which must be submitted with the aforementioned procedure codes. The physician and billers must also ensure that a billing is not placed as a consultation which is actually a new patient visit. They should be experienced and educated in compliances, ICD-10 and CPT codes, and carefully unbundle procedure codes that are globally the same. Also, according to insidethecircle.net, recent changes to CPT codes must be kept in mind for compensation. 1. Hysterectomy bundling requires including anterior/posterior colpopexy and colporrhaphy procedures into the laparoscopic-assisted and vaginal hysterectomy codes. New codes were added for fetal chromosomal aneuploidy for genomic sequencing, analysis of chromosomes, human papillomavirus lowrisk, human papillomavirus high-risk, human papillomavirus types 16 and 18 only, vaccination codes and others. New codes have been devised for laparoscopy surgical ablation of uterine fibroid(s), including radiofrequency and intraoperative ultrasound guidance and monitoring. 2. Avoidance: As per beckersasc.com, there are a few unexpected procedures that are denied: • 99000: Specimen handling office-lab • 99213: Outpatient doctor visit, level 3

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• 81002: Urinalysis non-automated without scope • 36415: Routine blood capture • 99214: Outpatient doctor visit, level 4 Reason codes for denials: • 97: Benefit for service is already included in the payment for another service/procedure already adjudicated. • 18: Duplicate claim/service • 16: Claim lacks information or has errors • 234: Procedure is not paid separately. • 96: Non-covered charge(s) Such causes must be avoided by billers and coders. 3. ICD-10: It is essential that all pregnancies are coded as per every trimester. Care should be taken while documenting an annual gynecology exam. Pelvic pain and its causes must be documented, migraines must be reported especially if related to chronic menstrual migraines, fetus visibility must be documented (add reasons such as it being a regular scan or a miscarriage), and lastly, specify if the patient's age impacts pregnancy and/or its complications. 4. Adequate Documentation by physicians and surgeons is required at all stages, preoperative and postoperative care too. It has been noted that a reduction in the assigned value of units has caused the payments to decrease. The Laborist Model benefit: According to acog.org, 'The laborist model offers the theoretical advantages of freeing the practicing OBGYN, with an office full of patients, from having office hours disrupted by a patient arriving on the labor suite; of markedly reducing on-call requirements, and improving family and personal life style of improving patient care, as well as nursing satisfaction, by having a doctor always available to see patients in the labor and delivery suite, and of freeing the nurses from the need to find someone to answer their questions and needs; and of improving the quality of medical care, and reducing medical legal risk. These are potential benefits that prevent physician “burn out Hence, a fully trained obstetrician is physically available 24 hours a day, on labor and delivery, with no assigned tasks or responsibilities elsewhere, to manage all patients who present to labor and delivery.' The billing team must ensure apt storage, billing and management of medical records for timely and accurate reimbursements to OB/GYN practitioners.

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