Gynecology Billing Best Practices

You’ve completed medical school, a four-year residency and passed all of your boards. You’re dealing with patients now and explaining the intricacies of pregnancy, childbirth and postpartum. You’re taking caring of your female clients overall health, literally around the clock. Given all this entails, should you also be trying to deal with the bureaucratic healthcare reimbursement system? We don’t think so and that’s why outsourcing your billing makes a ton of sense. Here’s a few things your billers should know before accepting your business.


Step 1) Avoid the Common Traps.

Some folks say Cash is King. For OB/GYNs, that means Coding is King. Coding requirements change regularly and coding errors can result in loss of revenue and payment delays. Coding optimization will unlock prompt reimbursements. But there are a few denials that trip billing companies up. According to statistics, those coding mistakes are as follows:

  1. 36415: Routine blood capture
  2. 81002: Urinalysis non-automated without scope
  3. 99000: Specimen handling office-lab
  4. 99213: Outpatient doctor visit, level 3
  5. 99214: Outpatient doctor visit, level 4


So why are these codes commonly denied? Well, its usually because of:


  1. Claim lacks information or has errors
  2. Duplicate claim/service
  3. Non-covered charge(s)
  4. Benefit for service was included already in the payment for another procedure
  5. Procedure is not paid separately.


All five reasons are preventable. We makes sure these mistakes don’t happen by implementing proper checks and balances into yours and our workflow.


Step 2) Prep Your Practice. 

There are a number of things that an OB GYN practice can do to prepare their billing claims in the transition to ICD-10 that can improve payment, report their services more effectively, and receive prompt reimbursement.


    1. Reporting annual gynaecological exam: Physicians are responsible for documenting annual exams for their patients, and specifying the type of test and the appropriate ICD-10 code. Take the time to verify the specifics of the exam and annotate it as such, including whether abnormal findings were or were not present, as this can affect the code assignment for the service. While a physician can bill an E/M code for the visit, the cervical smear test must be billed by the lab only.
    2. Documenting Specify trimester: The ICD-10-CM Manual requires the reporting of the specific trimester of the patient. The physician can choose to list the trimester specifically or simply denote the number of weeks and days of pregnancy, so the coder can calculate the trimester before submission. Submitting unspecified trimester can reflect poorly on the physician and their attention to detail in their patient care.
    3. Documenting cause of Pelvic Pain (Gastric or Menstrual): If the physician is able to determine the cause of the pelvic or abdominal pain associated with menstruation, the diagnosis should be clearly documented in the patient portfolio. By specifying the cause of the pain adhesions, cystic ovaries, menorrhagia, or others the coders can ensure they capture the correct coding requirements for your patient.
    4. Documenting Chronic Migraines with Menstrual Cramps: Carefully document your patient’s experience with migraines, especially when associated with their cycles.
    5. Reasons for Fetus Visibility Scan:If the scan was performed as a routine screening or whether it was to see if there were any signs indicating a possible miscarriage need to be specified to ensure the proper coding.
    6. Consider Advanced Maternal Age: If your patient is pregnant and is over 35 years of age, she may be considered advanced maternal age. Specify this in your documentation, and also what specific problems might be experienced.


Step 3) Hire EchoScribe

We are a high touch, personalized medical billing and coding service that will cater our offering to your needs. Our low-cost offering has motivated over 60 healthcare institutions to make the switch from their in-house provider to our medical billing service. Our value proposition resonates well with physician practices keenly focused on their bottom line. While we may be small compared to some of our competitors, our impact on clients is huge. Let us handle all of your OB/GYN billing needs.

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