Ob-Gyn Coding Alert

Establish a policy for waiting six weeks after the patient leaves the hospital.

When an ob-gyn patient comes into a hospital for a medical problem, the initial diagnosis may not stay the same the entire time, which means you have to be flexible with how you’ll code these encounters. And if you bill for your physician’s hospital visits with an out-of-date diagnosis, you could lose money or face fraud charges.

The problem: Diagnoses can change in the hospital due to various reasons, including the following, among others:

• The physician may narrow down the patient’s problem. For example, a patient may be admitted with abdominal pain (R10.-, Abdominal and pelvic pain …), and the doctor may rule out appendicitis and decide the problem is actually an ovarian cyst that has ruptured (such as N83.0, Follicular cyst of ovary).
• The patient may develop other problems. The patient may be admitted for dehydration problems (E86.0, Dehydration) but may start having vaginal bleeding (N93.9, Abnormal uterine and vaginal bleeding, unspecified).
• The patient may experience complications that lead their original complaint to worsen significantly.

You shouldn’t wait for the hospital to send you medical records and hope to bill in a timely fashion. You could be waiting six weeks after the patient gets out of the hospital for any records. Establish an internal policy for your practice for collecting hospital records and depend on the physician documentation for changes in the patient’s diagnosis or condition.

Do this: Educate your physicians and let them know that just because the patient has been admitted with a particular diagnosis doesn’t mean they should bill for that diagnosis for each visit.

To help your physician track his hospital visits, you might consider giving each physician a simple form to record these evaluations. The physician could put a sticker with the patient’s hospital identifier on the form and then write the date of each visit, the level of service, and the diagnosis. Each sheet will have room for 10 or 12 patient visits.

Diagnosis Tracking Is In the Cards

Another approach is to give your doctor a bunch of index cards that fit in the pockets of a lab coat. The physician uses one card for each patient and notes each visit to the patient for a given week. At the end of the week, the physician turns in each card. The cards have a space at the bottom for the patient’s diagnoses, which the physician should date.

If your physician doesn’t admit the patient to the hospital, then chances are the diagnosis they treat won’t be the admitting diagnosis anyway.

For example: Suppose an internal medicine physician admits the patient for pneumonia, but then the patient develops unexplained left lower quadrant pain (R10.32, Left lower quadrant pain). The admitting physician does an ultrasound and discovers a torsed ovary (N83.53, Torsion of ovary, ovarian pedicle and fallopian tube). The ob-gyn is called in to evaluate and treat the patient for this condition. The ob-gyn’s diagnosis codes will reflect the patient’s new problem, says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

Watch out: If you’re not billing with the most up-to-date diagnosis, you may not be able to justify a higher level of service. The patient may have been admitted with a simple problem and then developed complications, so a subsequent visit could have more complex medical decision making. But you won’t be able to justify a higher-level code unless you know all the diagnoses.