Ob-Gyn Coding Alert

Check out how you too can pave the way for your fellow coders.

Every so often, you may encounter a situation where you know the payor is making a mistake. Rather than accept defeat and leave precious money on the table, you should fight for what you know is right. Here’s what one coder did to make her point known.

Scenario: A patient comes in for her annual preventive visit and her Pap smear returns abnormal. She comes back for a 3 month repeat Pap smear that returns as normal. She returns 3 months later for a third repeat Pap. The third Pap should be reported with diagnosis V72.32 (Encounter for Papanicolaou cervical smear to confirm findings of recent normal smear following initial abnormal smear). This is an E/M problem visit and is reported with E/M codes (99201-99215, Office or other outpatient visit for the evaluation and management of a new/established patient)

Problem: Payors like Blue Cross Blue Shield of Tennessee denied these claims, saying that you should only report V72.32 with preventive codes. That is in direct contrast to the advice from the American Congress of Obstetricians and Gynecologists (ACOG), which states that you can report V72.32 with a problem E/M service code.

What One Veteran Coder Decided to Do

Lana Flatt, CPC, a veteran coder for Ob Gyn Associates in Cookeville, Tenn., decided to take matters into her own hands and sent a letter to Blue Cross Blue Shield of Tennessee regarding the denial of V72.32 with E/M codes. Included were scenarios similar to that above, along with supporting information from ACOG. The provider representative reviewed the information with the BCBST medical director— and he agreed. “They are overturning the edit and reprocessing all denied claims!” Flatt exclaims.