Ob-Gyn Coding Alert

Don't just watch for updates - be sure you select proper 4th, 5th digits

If you've received a denial stating the service the ob-gyn provided was "medically unnecessary," you've got one problem: your diagnosis coding. Protect yourself from time-consuming appeals with these important specificity requirements.

Many coders neglected to pay the necessary attention to ICD-9 coding until recently "because Medicare was the only carrier that cared if you used the correct codes," says Victoria Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. Check for These Helpful Guides You should always report the ICD-9 code that provides the highest degree of accuracy for the condition the ob-gyn is treating. "That 'highest degree' means that you should assign the most precise ICD-9 code that most fully explains the narrative description of the symptom or diagnosis," says JoAnn Baker, CCS, CPC-H, CPC, CHCC, an education specialist in East Orange, N.J.

Rely on your ICD-9 manual's instructions to ensure you're listing complete ICD-9 codes. If you see a check mark with a "4th" or "5th" next to a code, ICD-9 is telling you that the code requires a fourth or fifth digit. Anything less would result in an incomplete claim.

Example: If an ob-gyn patient who is not pregnant presents with vulvitis NOS, you're likely going to report 616.1x (Vaginitis and vulvovaginitis). But coding shouldn't stop there. You've got to add "0," which means "vaginitis and vulvovaginitis, unspecified," says Jennifer Ohmart, medical billing, coding, and insurance specialist at Anne Walters, CNM, Susan McConaughy, CNM, Amy Wallace, CNM, Wayne Furr, MD, Ob-Gyn, in Englewood, Colo.  "NOS" means "not otherwise specified," which is why 0 is the correct fifth digit.

If the patient is pregnant and has vulvitis NOS, you'll report 646.6x (Infections of genitourinary tract in pregnancy) and add a fifth digit (0-4) to represent the current episode code such as 1 for "delivered, with or without mention of antepartum condition." 

Such careful coding is especially necessary for the ob-gyn treating a pregnant patient, because the ob-gyn is likely treating the complications of the pregnancy rather than caring for the pregnancy itself. Without the proper ICD-9 to indicate the complications, the insurer would likely rule an ob-gyn's care incidental and part of the global ob package.

Key idea: If the ICD-9 code is not as specific as carrier rules require, the claim may be rejected for lack of medical necessity and/or a truncated code, says Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont.

Always Advance Your New Code Knowledge Another factor that results in piles of denials is the use of expired diagnosis codes.

For example, as of Oct. 1, 2005, you need to report the four-digit code [...]