Ob-Gyn Coding Alert

Ob-gyn lab claims have a higher 24.9 percent error rate.

Your ob-gyn practice is probably active and bustling every day, but it’s possible that with all that activity, correct coding could be falling through the cracks. Ob-gyn practices logged a 7.7 percent error rate, which is only slightly less than the general Part B population, according to the latest report from CMS.

The backstory: CMS issued its “2018 Medicare Fee-for-Service Supplemental Improper Payment Data” on November 30 as part of its Comprehensive Error Rate Testing (CERT) program. The report breaks down the biggest errors among Medicare claims, and covers the causes of the improperly paid charges. Overall, the government found an 8.1 percent improper payment rate among Part B claims during 2018.

Ob-Gyn Visits Still Logged Millions in Part B Errors

On the list of the services with the most Part B improper payments, CMS reports ob-gyn visits logged a 7.7 percent error rate, totaling over $42 million in improper payments.

This makes the ob-gyn visit error rate only slightly less than the overall Part B error rate of 8.1 percent.

The cause might be the following:

• Established office visits had a 66.4 percent incorrect coding error rate and a 24.5 percent insufficient documentation error rate. »
• Initial hospital visits had a 66.4 percent incorrect coding error rate and a 30.3 percent insufficient documentation error rate.
• Subsequent hospital visits had a 48.4 percent incorrect coding error rate and a 41.3 percent insufficient documentation error rate.

Major problems: Non-Medicare fee schedule lab tests, non-Medicare fee schedule minor procedures, and the “other specialty” category were all hit with over a 90 percent insufficient documentation rate.

That means you need to be careful to focus on your coding accuracy and supporting documentation.

Avoid These Common Errors

Although many practices may be focusing on the millions of dollars in errors recorded for ob-gyn, keep in mind that not all of them were due to overcoding. Many of the errors involved undercoding and underpayments, which meant that these doctors actually deserved more money than they billed. Of course, these types of problems are still considered errors and “incorrect coding,” so it would be best to put checks in place to prevent these issues going forward.

The stats: According to the report, about $13 million of office/outpatient visits were incorrectly paid due to downcoding — in particular, 99212 (Office or other outpatient visit for the evaluation and management of an established patient…) alone had a 22.2 percent underpayment rate.

On the flip side, some $214 million in Part B payments were incorrectly paid due to upcoding errors. In particular, initial hospital visits logged a 15.9 percent overpayment rate.

Incorrect coding: When it came to incorrect coding errors, office and hospital care visits ranked high on the total list of services with these issues. Hit particularly hard were office visit codes 99214 and 99213 and subsequent hospital care code 99233.

Are You Downcoding Office Visits?

With millions in ob-gyn visits being undercoded — much of it involving 99212 — you may be wondering if your practice makes up part of that number. Check out these quick tips to ensure that you aren’t shorting your ob-gyn’s income.

Tip 1: Remember than when billing this level 2 established patient service, the ob-gyn is focusing on a single issue.

Tip 2: That single issue is minor, or it is following up with the patient regarding conditions that are either now under control or require no more follow-up.

Tip 3: This level of service is not normally appropriate for evaluating new presenting problems or problems that continue to require monitoring.

Tip 4: However, it is the documentation that is essential here in raising the level of service above that required for a level 2 visit.

Resource: To read the full CERT document, visit https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Downloads/2018MedicareFFSSuplementalImproperPaymentData.pdf.