Ob-Gyn Coding Alert

Using the proper code can make you $200 per week You could be missing the perfect opportunity to use the higher-paying consultation codes (99241-99245).
 
If a surgeon requests your ob-gyn's opinion regarding surgical clearance for a patient, the preoperative exam or service qualifies as a consultation if the ob-gyn documents the reason for the request and issues a report of his findings to the requesting surgeon. Get an Extra $38 With 99242 Many practices are losing this deserved revenue because they're reporting an office visit, such as 99213 (Office or other outpatient visit for an established patient ... 15 minutes face-to-face) or 99214 (... 25 minutes face-to-face). But the consultation codes, for instance 99242 (Office consultation for a new or established patient ... 30 minutes face-to-face) and 99243 (... 40 minutes face-to-face), reimburse at a much higher rate.
 
In fact, 99213 reimburses approximately $38 less than its consultation equivalent 99242, based on national Medicare allowances. Because the ob-gyns do the work for a consultation, they should be paid for it. 99213 and 99242 Require Similar Elements Despite the revenue disparity, 99213 and 99242 basically require the same elements. The difference is that 99213 requires only two of the three key components - expanded problem-focused history, expanded problem-focused examination, and/or low-complexity medical decision-making, says Judy Richardson, RN, MSA,
CCS-P, a senior consultant at Hill and Associates, a coding and compliance consulting firm in Wilmington, N.C. CPT specifies the same history and examination requirements for 99242 but allows straightforward medical decision-making.
 
But remember, 99242 requires the provider to document all three components, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.
 
For example, a general surgeon requests that an ob-gyn clear a 35-year-old ob patient in her first trimester for gallstone surgery. The general surgeon wants to make sure he can safely perform surgery without risk to the patient or her fetus. The ob-gyn performs an expanded problem-focused history, expanded problem-focused examination and straightforward medical decision-making.
 
This preoperative exam would qualify for either 99213 or 99242. But in this situation, you should choose 99242 for the ob-gyn's service. On the other hand, if you choose the office visit code (99213, which contains 1.42 relative value units [RVUs] and reimburses $53.02) instead of the consultation code (99242, which has 2.45 RVUs and pays $91.48), you will cost your practice $38.46 per visit, based on the Medicare Physician Fee Schedule.
 
On average, ob-gyns perform four to five preoperative exams per week, some experts estimate. Consequently, if you're using 99213 instead of 99242, you may be sacrificing nearly $200 in revenue per week. Look Closely at Chief Complaint and Findings To gain this ethical [...]