Four Coding Myths That Will Cost You

Four Coding Myths That Will Cost You

Ob-Gyn coding is a serious medical billing issue. There are many assumptions and myths that billers make when filing claims. Assumptions can cost your practice a lot of money. There are four myths in Ob-Gyn medical billing you should forget.

1st Myth
It is incorrect to bill separately for the initial blood work with a nurse and also the initial ob-gyn visit. If blood work is being done, that should be included in the initial visit code, or the global package in medical billing. If your practice has been billing separately for these services, you may eventually need to repay overpayments.

2nd Myth
Another myth in OB-Gyn medical billing is that you should always use diagnosis code 626.0 when the patient comes in to confirm pregnancy. Unfortunately, this is incorrect. This medical billing code is for amenorrhea which means no period for six months or no period for three months with irregularities. Since this code represents a disease, this would be incorrect when merely confirming pregnancy. Instead, you can report the medical billing diagnosis code V72.42 (Pregnancy confirmed). This will take care of your problem.

3rd Myth
It is important to know that V72.42 in medical billing does not mean that your physician began the Ob care. Many coders do think that this new diagnosis code will signify to payers that they began the patient’s care. This is not true. When doing medical billing for a pregnant woman, it is perfectly acceptable to only use V72.42 instead of 626.8.

4th Myth
A threatened abortion is allowed to have separate medical billing from the global fee. Since the maternity global billing includes everything in a normal pregnancy, miscarriages are not included in this medical billing. A missed abortion is not considered normal. The correct medical billing diagnosis codes to use are 640.03 and 640.83.

Be sure your medical billing staff members understand the correct rules and aren’t following Ob-Gyn coding myths.

View all Articles by: Melissa Clark, CCS-P