Ob-Gyn Coding Alert

Applying ICD-9 codes to an ob global package can make -- or break -- your claim.

The following tips, provided by Laura Knight, CPC, project coordinator of medical services administration at Good Samaritan Community Healthcare in Puyallup, Wash., will ensure your global ob package success every time.

Item 1: Make sure you choose all ICD-9 selections for ob billing from the 640-677 range of ICD-9 diagnoses.

Item 2: Always code to the highest specificity when you need to add a fifth digit to denote the episode of care (such as for complications mainly related to pregnancy, 651-659):

- unspecified = 0

- delivered, with or without mention of antepartum condition = 1

- delivered, with mention of postpartum complication = 2

- antepartum condition or complication = 3

- postpartum condition or complication = 4.

Item 3: Remember that ICD-9 selection in the 646.x (Other complications of pregnancy, not elsewhere classified) or 648.x (Other current conditions in the mother ...) diagnosis categories requires additional codes to further specify the complication, says Karla Lee-Graves, practice administrator for Azalea City Physicians for Women in Alabama. For example, you-ll need to further specify 648.0x (Diabetes mellitus) using a code selected from the 250.xx series (Diabetes mellitus), Graves says.

Item 4: If possible, use the outcome codes for the delivery (V27.0-V27.9).

Item 5: Don't miss out on extra reimbursement for twins. Here's how to report three types of twin deliveries:-

- Both vaginally: If your ob-gyn delivers both babies vaginally, you should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for baby A and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; multiple procedures) for baby B.

- Both by c-section: If the ob-gyn delivers both babies by c-section, you should report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) and attach modifier 22 (Increased procedural services). Include a letter with the claim that outlines the additional work involved with the multiple procedures to give the carrier a clear picture of why you-re asking for additional reimbursement.

- One vaginally, one by c-section: If the ob-gyn delivers baby A vaginally and delivers baby B by c-section, you should report 59510 for the second baby and 59409-51 for the first. Don't forget to use a code in the 651.xx series for multiple gestations, because using one of these codes will ensure your claim gets processed quickly.