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OB GYN Billing and Coding: How to Avoid Claims Denials

July 19, 2018

OBGyn BillingWithin changes in Current Procedural Terminology (CPT) codes and the implementation of ICD-10, many OB/GYN practices have faced medical billing and coding difficulties that have increased claims denials and slowed the practice revenue cycle. OB/GYN billing and coding comes with unique challenges because of the voluminous claims filing that comes with a practice that covers Obstetrics, Anesthesia for procedure, Gynecology, and Family Planning. If you’re practice is dealing with excessive claims denials that are hurting revenue, here’s a look at several strategies you can use to avoid claims denials and start improving revenue for your OB/GYN practice. 

Be Well Informed on Coding Updates

One of the best ways to make sure claims aren’t unnecessarily denied so you can maximize reimbursements is to stay well informed on coding updates that affect OB/GYN practices. Within the past few years, several changes in CPT codes have been made, so it’s important to stay up-to-date. For example, in 2017 there was a removal of the bull’s eye symbol, which indicated moderate sedation was used for a OB/GYN procedure. That symbol was removed for several CPT codes, including 10030 (fluid collection drainage by catheter, image guided), 49407 (retroperitoneal or peritoneal, transrectal or transvaginal), 57155 (insertion of vaginal oviods and/or uterine tandem for clinical brachytherapy). A regular CPT code has also been added for the laparoscopic ablation of fibroids, code 58674. Failing to be updated on current coding updates has the ability to cost your practice thousands of dollars, which is why it’s so important to work with billing and coding specialists that are current in their knowledge. 

Avoid the Most Common Causes of OB/GYN Denials 

It helps to be aware of some of the most common causes of OB/GYN denials so you can avoid them. A Physician’s Practice report noted that in the past some of the top unexpected denials have included: 

  • 99214 – Outpatient doctor visit at a level 4
  • 99000 – A specimen handling office-lab
  • 81002 – Non-automated urinalysis without a scope
  • 99213 – Outpatient doctor visit at a level 3
  • 36415 – Routine blood capture 

There are several different reasons that these denials occur. In many cases, they get a code 18 denial for a duplicate claim or service, while it’s often common that the claims are denied because the benefit for service was already included in the payment of another procedure or service. These claims may be denied because the procedure isn’t paid for separately, the charge isn’t covered by the payer, or it could just be that the claim has errors or lacks essential information required for reimbursement. 


OB/GYN ICD-10 Specific Tips to Remember 

Most practices have made the transition to ICD-10, but there are still some helpful ICD-10 specific tips that OB/GYN practices need to remember. Here’s a look at a few tips your practice needs to keep in mind to avoid denials: 

  • Specific trimesters need to be documented. For example, using the new ICD-10-CM code O09.01 is for the supervision of a pregnancy with an infertility history within the first trimester. Be aware that codes may vary depending on the specific trimester. 
  • The cause of pelvic pain needs to be documented if it is known. 
  • If a patient’s age is complicating a pregnancy. For example, for patients over 35 years old, indicate whether their age may affect their delivery. 

Read More: Specialty Specific Medical Billing Service Advantage

  • If fetus visibility scans are done, document the reason. Specify whether it’s simply a routine screening or there have been signs that may indicate a potential miscarriage. 
  • Be careful when documenting annual gynecological exams, since the annual GYN exam code is in ICD-10-CM chapter 21 instead of in chapter 15 where you may expect it. The code for a routine GYN exam is Z01.4.  

Is it Time to Outsource OB/GYN Billing and Coding? 

Even small errors can end up causing claims denials, and with all the voluminous claims filing that comes with OB/GYN billing and coding, it could be a good option for your practice to outsource your billing and coding. Finding quality, in-house billing and coding specializes that have obstetrics and gynecology billing and coding expertise can be difficult, which is why many OB/GYN practices choose to outsource. If your practice is constantly trying to balance efficient medical care with an uninterrupted flow of reimbursements, outsourcing can give your practice the ability to focus on patient care while someone else takes care of the intricacies of billing and coding for you. 

M-Scribe is an expert in billing and coding for OB-GYN practices. Whether you’re starting a new practice or you want to increase revenue for an existing practice, contact contact us today to find out how we can help you avoid common industry pitfalls and help you maximize revenue. 


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