The 4 Big Myths of OB-Gyn Medical Billing

OB-Gyn medical billing can be very confusing and some physcians will under code their medical billing claims as they fear an audit so they don’t submit full claims but in fact, this practice will cost you money. In order to understand OB-Gyn billing fully, you must understand the myths associated. There are four medical billing myths associated with OB-Gyn medical billing that may be holding back your reimbursements.

The first myth deals with the initiation of the ob record. If both the ob-gyn and the nurse see the patient for initial blood work, you should not report a minimal code for both instances. In OB medical billing, you should report a 99211 for the initial blood work. This is an established visit code. Any visits thereafter should all be included in the global fee. Many medical billing staff members think two lab visits are excluded from the global fee, but they are not.

The second medical billing myth deals with the diagnosis code used when pregnancy is being established. Many billers feel that 626.0 (Amenorrhea) should be reported during the initial workup. As-a-matter-of-fact, this is incorrect. Amenorrhea is a disease and should only be used when a menstrual cycle has been missing for six months or for three months with documented irregular periods. Instead, in medical billing you should use the code 626.8 (Missed period) on your claims. This plainly states that there is a missed period, but that no worry of disease is imminent.

The third myth deals with a large medical billing assumption. Many believe that if you bill V72.42 as a diagnosis code, that payers will assume your practice started the pregnancy record. Do not assume anything! If your physician began the OB care, be sure your documentation or other coding practices support it.

The final OB medical billing myth is that you need to include a threatened abortion or miscarriage in the global care fee. The fact is, a global fee for maternity deals with any care that is usual and customary. A threatened or missed abortion is not customary, so you may code separately for these services in medical billing.

If your practice understands these OB-Gyn myths, your medical billing reimbursements will improve with your next set of claims.

View all Articles by: Kathryn Etienne, CCS-P