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Avoiding Claims Denials for OB/GYN
Claims Denials for OB/GYN are a thorn in the flesh for most medical practices. However, some specialties have an exceptionally high denial rate. Unfortunately, OB/GYN is one of them. Denial rates in this specialty are the highest, at 22.42%. Denials are an everyday occurrence for most OB/GYN centers. OB/GYN billing and coding present unique challenges due to the high volume of claims filed for a practice that covers Obstetrics, Anesthesia for procedures, Gynecology, and Family Planning. If your practice is experiencing excessive claims denials, hurting revenue, here are several strategies to avoid claims denials in OB/GYN and improve revenue.
Common OB/GYN Procedures and Their CPT Codes 1. Hysterectomy: o
Abdominal hysterectomy: CPT 58150
o
Vaginal hysterectomy: CPT 58260
o
Laparoscopic hysterectomy: CPT 58570
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2. Myomectomy: o
Abdominal myomectomy: CPT 58140
o
Laparoscopic myomectomy: CPT 58545
3. C-section (Cesarean section): o
CPT 59510
4. Ovarian Cystectomy: o
Laparoscopic ovarian cystectomy: CPT 58662
o
Open ovarian cystectomy: CPT 58925
5. Endometrial Ablation: o
CPT 58353
Most Common Causes for Claims Denials for OB/GYN There are so many facets to appealing a denied claim. While each denial may seem the same, each one is unique. The first thing one should do when a claim is rejected is to review the EOB and determine why it was denied. It helps to be aware of some of the most common causes of OB/GYN denials to avoid them. You usually get a code 18 denial for a duplicate claim or service. At the same time, it’s often expected 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 payer doesn’t cover the charge, or it could just be that the claim has errors or lacks essential information required for reimbursement.
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Keep a Close Eye on Coding Updates One of the best ways to ensure claims aren’t unnecessarily denied so you can maximize reimbursements is to stay well-informed on coding updates affecting OB/GYN practices. Several changes in CPT codes have been made within the past few years, so it’s essential to stay up-to-date. Failing to be updated on current coding updates can cost your practice thousands of dollars, which is why it’s so important to work with billing and coding specialists who are current in their knowledge. With the new 2019 ICD-10-CM code set, more than 30 changes apply to OB/GYN. These changes include updating coding multiple gestation pregnancies to coding for obstetric surgical wound infections.
Follow Best Practices for OB/GYN Coding
Specific trimesters need to be documented. For example, using the new ICD10-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, patients over 35 indicate whether their age may affect their delivery.
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 yearly 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.
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Outsource to avoid Claims Denials for OB-GYN Even minor errors can cause Claims Denials for OB/GYN, 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. OBGYN coding is already tricky, and these new changes to the ICD-10 codes for 2019 only add to coding difficulties for your practice. Simply forgetting to add additional characters to codes that specify a type of surgical wound is enough to get your claim denied, and denials can cost your practice big time. Through outsourcing, many OBGYN practices can improve billing and coding efficiency and focus more on offering quality patient care. Medical Billers and Coders is a reputable medical billing and coding company that offers the highest quality service for clients nationwide. Contact us today to learn more about how we can end your OB/GYN billing and coding difficulties. It is critical to follow the appeals process laid out by the payor. Never assume payor appeals processes are identical. Mark the dates for deadlines and plan on sending appeals 4 -5 days before a deadline. Repeat this for each level of appeal. A winning appeal always involves solid payor policy research, supplying complete medical records (with Orders, Lab Results, X-ray Reports, and the works to ensure medical necessity), and crafting a well-written appeal letter addressing the denial reasons while providing vital details of support from the documentation.
FAQs 1. Why do OB/GYN practices have high denial rates? OB/GYN practices face high denial rates due to the complexity of claims involving services such as Obstetrics, Anesthesia, Gynecology, and Family Planning. The intricacies of coding and the volume of claims filed contribute to the high rate of denials, which can significantly impact revenue. Call now 888-357-3226 (Toll Free)
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2. What are some common causes of claims denials in OB/GYN? Common causes of claims denials in OB/GYN include duplicate claims, lack of essential information, procedures not covered by the payer, and failure to follow updated coding guidelines. These issues can result in claims being denied because they were already included in the payment of another procedure or service. 3. How can OB/GYN practices avoid claims denials? To avoid claims denials, OB/GYN practices should stay informed about coding updates, such as changes to CPT and ICD-10 codes. Accurate documentation of specific details, like trimesters and reasons for procedures, is crucial. Outsourcing billing and coding to specialists can also help minimize errors and improve reimbursement rates. 4. What are some best practices for OB/GYN coding? Best OB/GYN coding practices include documenting specific trimesters, causes of pelvic pain, patient age complications, and reasons for fetus visibility scans. Accurate documentation, such as using the correct ICD-10-CM codes for routine gynecological exams and surgical procedures, is essential. 5. Why should OB/GYN practices consider outsourcing their billing and coding? Outsourcing billing and coding can help OB/GYN practices reduce claim denials by ensuring accuracy and staying updated with coding changes. This enables practices to concentrate on delivering high-quality patient care while enhancing billing efficiency and minimizing administrative burdens. Medical Billers and Coders is one company that offers reliable outsourcing services for OB/GYN practices.
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