OB/GYN Coding and Reimbursement
Strategies to develop a successful reimbursement process
through coding & documentation
Presented by
Susan Roskos , CPC
~ Certified Professional Coder
and an active member of the American Academy of Professional Coders
Sponsored by
Diversified
~ an e-Outsourcing company for medical practices and small businesses.
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is distributed with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.
From a Declaration of Principles jointly adopted by a Committee of the American Bar Association and a Committee of Publishers
Copyright 2010, Susan Roskos and Diversified.
No part of this workbook may be reproduced in any manner
without the expressed written consent of Susan Roskos or Diversified.
TABLE OF CONTENTS
TOPIC PAGE(S)
OB/GYN Coding & Reimbursement Process 3
Coding Documentation & Input 4
Common Errors Causing Denied or Rejected Claims 4
Developing your Coding Teams 4
Results of Ineffective Coding 5
Medical Record Documentation 6
Superbills, Encounter Forms and Auditing Tools 7-8
Making it easier for the Physician 9
Medicare Challenges –Preventive Medicine & Screenings Coverage & Guidelines 10-12
ICD-9-CM 13-17
Local Coverage Determinations 18
Linking ICD-9-CM 19
Introduction to ICD-10 20
ICD-9-CM Changes for 2010 21-22
ICD-9-CM Coding Exercises 23-24
HCPCS Coding System-Structure & Hierarchy of Selection 25
HCPCS Level II Codes 26
CPT-4 Definition, Structure, Instructions & Guidelines 27
Surgery Guidelines, Add-on codes, Separate & Starred Procedures 28
Modifiers 29
NCCI Edits & Unbundling 30-31
Evaluation & Management Selection Criteria 32-34
Office, Outpatient, Observation, Inpatient, Consultations, Preventive Medicine & Counseling 35
Biopsy, Destruction, Excision of Neoplasms and LEEP / Cervical Conization 36
Dilation and Curettage, Myomectomy, and Hysterectomy 37
Global Delivery, Antepartum & Postpartum care, Ectopic Pregnancy & Ultrasound 38 CPT-4 Changes for 2010 39
CPT-4 Coding Exercises 40-43
Documentation & Coding Resources 44
CODING & DOCUMENTATION INPUT
· Physician: Identifies and documents E&M level (CPT)
Identifies and documents diagnosis and/or symptom
Identifies and documents future services
· Medical Assistant / Nurse: Communicates diagnosis and/or symptom
to outside lab, radiology or other facility
· Receptionist: Verifies above information is accurate and complete at checkout
· Scheduler: Identifies auth requirements and ensures auths obtained
· Coder: Assigns and links accurate CPT and ICD-9 Codes to services
rendered.
· Biller: Submits accurate CPT/ICD-9 codes and demographic information to
correct insurance carrier
· Accounts Receivable Manager: Verifies accurate reimbursement from carrier
and submits appeals when necessary
COMMON ERRORS CAUSING DENIED or REJECTED CLAIMS
· Invalid codes
· Procedures not supported by medical necessity (diagnosis codes)
· Claims filed with the incorrect carrier
· Modifiers missing or used incorrectly
· Missing illness, injury or hospitalization dates
· Data entry errors (i.e. SS number, date of birth, etc)
· Invalid subscriber ID
· Procedures improperly linked to diagnoses
DEVELOP YOUR CODING TEAMS
Doctor – Nurse / Medical Assistant - Coder
Receptionist – Appointment Scheduling
Data Entry – Coder – Accounts Receivable Manager
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