Medical Billing for Ob-Gyn Claims Made Easy

As you know, the CPT 2006 injection coding instructions now require that the ob-gyn’s presence be verified during an injection which is coded as 90772 or the procedure must be reported as a non nonphysician-performed procedure as 99211. The latter can result in a no-charge depending on the payer’s policies.

You need to make sure you answer these questions:

*Is the Doctor in the office and available at the time of injection?
If you can answer yes, you can report this medical billing claim as 90772. If you cannot answer yes, then you have to use 99211 that is for injections given without direct physician supervision. The requirement does not mean the ob-gyn must be present in the exam room- the requirement is that the physician be in the office and available during the procedure.

*Does your documentation support the fact the doctor was present and/or available?
As you are aware, documentation is a big thing. The requirements state the direct supervising ob-gyn does not have to be the physician who created the standing order, but make sure you can prove the physician’s presence. Having a stamp made for your office that reads “Direct Supervision By” is a great way to meet this requirement.

*Does the carrier honor claims with lower-level supervision?
Check with the carrier’s rules before choosing a coding for this procedure. Not all carriers offer reimbursement for a non-physician assisted procedure.

Now that you know, use these three questions will make your decisions about the sometimes confusing medical codings to use on your medical billing claims.

View all Articles by: Melissa Clark, CCS-P