Ob-Gyn Coding Alert

Ask if you should code the ob-gyn's part of the test

Tests that your ob-gyn sends to outside laboratories for evaluations are usually more advanced than in-house tests--but that doesn't mean coding them has to be more advanced.

Find out the right questions to ask and determine your practice's relationship with the laboratory, and report these tests right every time.

Familiarize Yourself With the Usual Tests

Your ob-gyn probably sends tests such as Pap smear interpretations, blood panels and quantitative hCG tests for pregnancy to outside laboratories that have equipment and staff to study the specimens. Keep in mind: Because your ob-gyn is the physician drawing the specimens for these studies and sends them to a lab, your practice is responsible for one aspect of the test, and the pathology lab is responsible for the other.

This relationship, however, is not always the case. -We have an employee from a local lab company who performs all of the lab draws, and then the lab company bills for these services. This has helped tremendously with the billing process,- says Terri R. Viar, CPC-A, an ob-gyn coder at Women's Care PA in Shawnee Mission, Kan.

Good practice: -We are always up front with our patients about lab services. They are costly but prove to be a good asset for their healthcare. Many lab services we provide for our patients are screening and, in many cases, are the patient's financial responsibility to cover,- Viar says. This is one reason why you-ve got to make sure you-re charging your lab fees correctly.

Evaluate Your Lab Coding

Read these scenarios and find out how the answers apply to your coding practices.

Scenario 1: A woman arrives for her regularly scheduled well-woman visit (9939x, Periodic preventive medicine ...) and undergoes a Pap smear. The E/M or preventive visit your ob-gyn provides that day generally includes the collection of the specimen for routine tests like this. You may attempt to report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) for private insurance or Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for Medicare patients. Reimbursement for this code will vary widely from payer to payer.

Scenario 2: If a patient shows up for her well-woman visit (9939x) and also complains of dizziness and fatigue, the ob-gyn may order a series of blood tests. Because drawing blood is not a routine part of well-woman care, you can report the blood draw with 36415 (Collection of venous blood by venipuncture). Most blood tests and other workups are often too complex for in-house ob-gyn labs. Your practice will likely send these tests to an outside lab.

In that situation, the lab should receive reimbursement for evaluating the specimens. Keep in mind that your practice may have an agreement with the lab to report the lab's portion of the services and simply pay the lab for its part later. In that case, you would need to add modifier 90 (Reference [outside] laboratory) to the lab test you are billing to inform the payer that you did not perform the tests.