Ob-Gyn Coding Alert
Get to the Bottom of the Different Edits
Question: I follow Correct Coding Initiative (CCI) edits, but some insurers don't follow these guidelines. Why not? Virginia Subscriber Answer: You-re right. Some insurers follow CCI edits, but some don-t. This is strictly up to each payer and its stated goals for coverage. Those that don't use CCI edits may follow McKesson edits instead. McKesson is a clinical editing system that is not in a public domain, and therefore you are not given specific information about what edits your payer is applying each time you bill. Most of the time, you learn what they are by following the denial patterns. For instance, Aetna follows McKesson edits and generally does not alter the edits that come with the package. CIGNA does as well, but you may find reimbursement after a review. And you may successfully overturn bundles with Blue Cross Blue Shield (BCBS) depending on the representative you talk to. However, other payers, such as UnitedHealthcare, do not follow McKesson edits at all. These insurers have developed internal edits that you may also not know about in advance.
Ob-Gyn Coding Alert
- Don't Miss Another ECC, LEEP, or Biopsy by Solving 3 Colposcopy Scenarios
Action: Isolating key phrases will capture the correct code every time Your colposcopy coding choices [...] - Coding From the Doctor's Note:
Ace Your Amnio Claims With This Expert Advice
Hint: 1 word will help you choose ICD-9, CPT codes If coding amnio procedures -- [...] - Expert Advice:
3 Tips Power Up Your Pessary Coding
Find out if the ob-gyn did a refitting at the time of an insertion If [...] - Remind MD to Fully Describe Pessary Conditions
Fight undercoding for pessary visits using this tried-and-true idea Good advice: Remember to fully document [...] - You Be the Coder:
Vaginal Hysterectomy With LSO and Colpopexy
Question: My ob-gyn completed a vaginal hysterectomy of a uterus that was less than 250 [...] - Reader Questions:
Clarify How You Report 93976
Question: My ob-gyn's documentation states, "I turned on the Color Doppler button to ensure the [...] - Reader Questions:
Abortion Short of 20 Weeks? Look to E/M Codes
Question: A 19.5-week pregnant patient arrived in the emergency department with bleeding and cramping.-She had [...] - Reader Questions:
Get to the Bottom of the Different Edits
Question: I follow Correct Coding Initiative (CCI) edits, but some insurers don't follow these guidelines. [...] - Reader Questions:
New Physician Doesn't Mean New Patient
Question: We have a new ob-gyn in our group whose patients from his previous group [...] - Reader Questions:
Figure Out These Fem Test Points
Question: Can I give two points for "independent visualization of specimen" toward an E/M level [...] - Reader Questions:
Solve This Surrogate Patient Situation
Question: Would you help me find a diagnosis code for a gestational carrier/surrogate? These patients [...]
