Ob-Gyn Coding Alert

Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the "Ob-Gyn Op Notes" session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.

Step 1: Itemize procedures.

Step 2: Assign CPT codes.

Step 3: Eliminate "standard" procedures.

Step 4: Eliminate bundled procedure that payers never pay (especially with Medicare).

Step 5: Bust bundled procedures that you know must be mistakes or are not reasonable. For instance, a vaginal hysterectomy with an anterior and posterior (A&P) repair is not a Correct Coding Initiative (CCI) edit, but some payers use a different edit program that may bundle these two. The reasons for the ob-gyn performing each service are different and distinct, so you should report these two procedures separately (even if you know a payer is trying to bundle them). Be prepared to appeal.

Step 6: List billable procedures in order of value (fee or relative value unit).

Step 7: Apply applicable modifiers (e.g., 59, 22, 52).

Step 8: Link each procedure to a justifying diagnosis. "This is the horse that pulls the cart," Witt says. For instance, for an enterocele repair, you should have an enterocele diagnosis.