Top Ob-Gyn Coding Challenges Your Peers are Facing in 2014

As an ob-gyn coder, you could be asking yourself several questions while coding for your ob-gyn’s services. For instance, if the ob-gyn conducts pap services when patients come for their yearly physicals, would you be getting paid for both services? Effective April 1, 2014, you also have a handful of ob-gyn edits to apply. Not sure which edits apply to your ob-gyn claims?

Many ob-gyn coders have told us they are struggling with their coding and billing this year. We’ve listed some of the top coding and billing challenges your ob-gyn peers are increasingly facing in their day-to-day work this year:

1. A fellow coder told me that for an established patient, I only need two out of three elements. Does that mean if I have a comprehensive history and a comprehensive exam, I can bill 99215 (Office or other outpatient visit ...)?
2. Does anyone bill 58661 with modifier 50 and get paid? Medicare used to consider this procedure as bilateral with payment indicator “0,” but in January 2010, they changed the payment indicator to “1.” CPT® describes 58661 as a bilateral procedure, and modifier 50 would not be appended. What should I do?
3. What is the diagnosis code for spotting when a patient is 17 weeks pregnant?
4. I used the Correct Coding Initiative (CCI) edits checker tool and entered 2 CPT® codes (58558 and 58559). There was no indication these codes cannot be reported together. However, when I use the CMS scrubber tool and enter the codes, I get a “critical” error message indicating the code cannot be reported, per CPT® relationship guidelines. I’m confused on what’s going on here.
5. The patient underwent 99395 25, 81000, 58301 -59, 99406 on the same day. How should I bill these codes?
6. What diagnosis code should I use when the physician notes the Dx as “post ablation bleeding?” The patient underwent ablation in 2010, and now the patient is having a lot of bleeding.
7. What is the CPT® code for initial anatomy ultrasound at 15 weeks gestation and the CPT® code for the follow-up “f/u” anatomy ultrasound?

If you too face challenges such as the above in your day to day ob-gyn coding, you could try the hotline to SuperCoder’s ob-gyn coding experts at http://www.supercoder.com/coding-answers/ask-an-expert. This forum allows ob-gyn coders like you to immediately ask questions and get instant replies with supporting information and explanation.