Ob-Gyn Coding Alert

You’ve read about what makes a good and bad Ob report, but here’s what you can do to make sure you’re reading the documentation correctly every time:

• Read the note all the way though to see if the title of the procedure matches the note. Always code from the note, not the title.
• Highlight the procedures the physician performed. If you have trouble understanding anything, ask the physician to explain.
• Assign codes.
• Check for any modifiers that might be appropriate and check the CCI edits for bundled codes.
• Have a colleague check your codes for accuracy.

Remember: Take your time. You’ll stand a better chance of getting it right the first time and avoid denials and appeals that may result from carelessness.