If you report the wrong diagnosis code, you may lose reimbursement. If you label a nonelective abortion as “complete” or “incomplete,” you may automatically establish your CPT® coding options for the ob-gyn’s services, regardless of what he or she may have done. Generally, you will designate nonelective abortions at fewer than 22 weeks gestation as spontaneous incomplete (634.x1), spontaneous complete (634.x2) or missed (632). Although technological advances enable physicians to detect pregnancy in its earliest [...]
Know Your Abortion Terminology (September 2011)
With so many different types of abortion, knowing the medical terminology is essential to coding related services based on your ob-gyn’s documentation. By being familiar with these common types of abortions, you take the first step to assigning the correct ICD-9 and CPT® codes:Complete – The complete expulsion or extraction from its mother of a fetus or embryo; complete expulsion from the uterus of any other product of conception (for example, blighted ovum).Elective – Without medical justification [...]
Pap Smears: Don’t Let Repeat Pap Smear Payment Slip Through Your Fingers (September 2011)
The wrong diagnosis code could cost you $41 per patient.If your patient’s Pap smear results return as abnormal or display insufficient cells, the ob-gyn likely will perform a repeat smear. Use proper E/M coding to get the payment you deserve.Pap smear results can return as abnormal for various reasons. For instance, if the patient has an inflammation, such as vaginitis (616.10), which affects the results of the Pap smear, the physician likely will treat the [...]
Beware the 1995 vs. 1997 guidelines pitfall by choosing just one at a time.When selecting an E/M code for an office visit there are multiple factors and when you throw in two sets of physical examination guidelines, your head can spin. Let our experts take the confusion out of the 1995 versus 1997 guideline debate with these top four exam questions.1. How Do I Determine the Physical Examination Level?There are two sets of guidelines you [...]
ICD-10: Prepare to Shift 617 Codes to N80 Codes in 2013 (September 2011)
You have reason to rejoice – here’s why.Endometriosis is a benign condition in which tissue that looks like endometrial tissue grows in abnormal places in the abdomen. Here’s how you report these conditions now:617.0, Endometriosis of the uterus617.1, Endometriosis of the ovary617.2, Endometriosis of the fallopian tube617.3, Endometriosis of pelvic peritoneum617.4, Endometriosis of rectovaginal septum and vagina617.5, Endometriosis of intestine617.8, Endometriosis of other specified sites617.9, Endometriosis site unspecifiedKeep in mind: When you use 617.8, you’re specifying [...]
You Be the Coder: Ambulance Delivery? Focus on What MD Provides (September 2011)
Question: One of our ob patients delivered on an ambulance on the way to the hospital. Our ob-gyn only took charge of the postpartum care. How should I report this?Wyoming SubscriberAnswer: You should only report the E/M services for her hospital care, such as 99220-99223 for admission; 99231-99233 for subsequent care; and 99238 or 99239 for discharge day management. If the ob-gyn also provides outpatient postpartum care, you should bill 59430 (Postpartum care only [separate [...]
Reader Question: Decipher Column 1, Column 2 CCI Codes (September 2011)
Question: Sometimes I cannot find the two codes I intend to bill in the CCI edits. How do I know which code would be considered a column 1 code, and which would be considered a column 2 code, which requires a modifier?
Supercoder.com/ForumAnswer: If the codes are not listed in the Correct Coding Initiative (CCI), the codes are usually not bundled. You would not need a modifier to override a non-existent edit. If the codes are [...]
Reader Question: 90385 or J2790: Query Payer for RhoGAM® Claim (September 2011)
Question: A patient came into our ob-gyn office just for a RhoGAM® shot and not for her return OB visit. A nurse provided the injection. The initial claim had 90384 and 96372 with V07.2. The insurance company denied it, saying it is not routine. Our office billed the patient for her deductible. Shouldn’t this be part of global care? Is the coding incorrect?
Georgia SubscriberAnswer: RhoGAM® is not part of a patient’s global care. Most [...]
Reader Question: Use Modifier 52 When Whole Delivery Not Performed (September 2011)
Question: We had a doctor that was on call. The husband delivered the patient. Then the doctor got there and delivered the placenta. How should report this?
Kentucky SubscriberAnswer: You have two options here. You can report the appropriate global ob code (such as 59400, Routine obstetric care including antepartum care, vaginal care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) with a modifier 52 (Reduced services). Another option would be to itemize [...]
Reader Question: Rely on Mod 22 For Lysis of Adhesions in this Case (September 2011)
Question: My ob-gyn treated a patient with a right tubal pregnancy with hemoperitoneum. I have 59151 for tubal pregnancy. Can I bill 58660 for the lysis of adhesions? What code should I bill for evacuation?
Vermont SubscriberAnswer: You should only report 59151 (Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy). If the adhesions were significant additional work and your ob-gyn documents that well, you should go with modifier 22 (Increased procedural service) appended to 59151. [...]
