Medical Billing Tips to Reign In Your Global OB Coding

The following tips will help to ensure success for your global ob packages every time. Make sure that you are getting the maximum reimbursement for your medical billing claims.

1. Make certain that all of your ICD-9 selections for OB billings have been chosen from the 640-678 range of diagnoses.

2. Always code to the highest specificity when you must add a fifth number to denote the episode of care (as in a case of complications mainly related to pregnancy, 651-659)
a. Unspecified = 0
b. Delivered, with or without a mention of an antepartum condition =1
c. Delivered, with mention of a postpartum condition = 2
d. Antepartum condition or complication =3
e. Postpartum condition or complication = 4

3. Always remember that ICD-9 selection in the 646.x or 648.x diagnoses categories require additional codes to specify the complication further.

4. Whenever possible, use the outcome codes for delivery (V27.0 – V27.9)

5. If the care provider repairs a third or fourth degree laceration on a patient, you should attach modifier 22 (which is unusual procedural services). In a situation like that, you should ask for extra reimbursement for the extra work.

6. Make sure you get the proper extra reimbursement for twins. There are three types of twin deliveries, and here is how to report them properly:
a. If both are delivered vaginally, you will report 59400 for Baby A, and 59409-51 for Baby B (59409-51 is vaginal delivery only with or without episiotomy and/or forceps).
b. If both babies are delivered by the OB by C-section, you will report 59510 and attach modifier 22. You will include a letter that outlines the additional work to give the carrier a clear picture of why you are asking for additional reimbursement.
c. If one baby is delivered vaginally and one is delivered via C-section, you should report 59510 for the second baby, and 59409-51 for the first. Do not forget to use a code in the 651.x series for multiple gestations, as using one of these codes will ensure your claim gets processed quickly.

View all Articles by: Melissa Clark, CCS-P