1. T

    Wiki How would you code physician Performed 76817 and a sonographer performed 76817 TC Billed Same Day, under Same Provider

    We have added on-site Ultrasounds to our clinic recently and are trying to determine how to code this scenario properly: The OB/GYN provider sees a patient for a Transvaginal ultrasound to confirm pregnancy or estimate gestational age (document requirements for 76817) and finds either twin...
  2. S

    Wiki Hysterectomy & Myomectomy

    I am far from an expert and actually very new to OBGYN specialty. I have a surgery that I am unsure of which CPT codes are appropriate and any advice would be appreciated. Case: Pre-procedure diagnosis: 1. Abnormal uterine bleeding 2. Dysmenorrhea 3. Uterine fibroids 4. Pelvic pain...
  3. R

    Wiki Billing For Midwives

    I am having trouble finding information on how we can bill for midwives. Our midwives go to a local hospital that we are contracted with and perform care and deliveries. The majority of the time our patients had their prenatal clinic visits with our midwives at one of our clinics. However when...
  4. M

    Wiki Colposcopy Coding Help

    Hi all I am still new to OBGYN coding, however, I have a provider who did a Colposcopy on a patient but is using B97.7 as the primary dx. I know that DX is not able to be primary but this patient has had 2 PAPs the last 2 years and both came back normal except this is the SECOND year in a row...
  5. M

    Wiki LMP Guidelines

    Are there any specific guidelines for reporting LMP? What if the patient doesn't remember her LMP? What if it's irregular and it was months ago but she's only 10 weeks?
  6. M

    Wiki OB Coding Z34 vs O09.9

    I'm stuck on this and I can't find a definitive answer anywhere. A routine prenatal encounter requires a Z34 code unless a code from chapter 15 is used. If a code from chapter 15 is used does it automatically make it a high risk pregnancy? For example if a O21.9 dx is coded then what is the...
  7. B

    Wiki Cystoscopy with stent placement

    I have gotten myself all confused and want to double check the code for a Cystoscopy with stent placement and Lysis of adhesions TIA
  8. H

    Wiki Retained POC After Elective Termination

    Hello ! We have a patient that had an elective termination of pregnancy at an outside clinic. She then came to our OBGYN office with retained products of conception and the doctor performed an outpatient suction D&C. I am having a hard time justifying which code to bill. I do not believe the...
  9. B

    Wiki Vulvar Resection Ulcer

    Hi all, I have been going in circles with this procedure and would appreciate any help/advice! Our provider performed a "right vulvar resection" for a non-healing ulcer of the vulva. The body of the report reads: "The labia was marked with a pen so that the entire non-healing ulcer could be...
  10. kdabis808

    Wiki New OB Visit & 59426

    Hello, I just started doing bililng for a new OBGYN. He seen patient as a New OB, and then seen patient six visits after. Patient delivered yesterday but he was not there to deliver. Would I still be using the new E/M code for the first 3 visits and then the 59425-59426 for the remaining? OR...
  11. M

    Wiki Well Woman Exams

    I am billing for a 99396 for this patient. Looks like she was also seen for cyst in a different office and told to see a GYN. The doctor reported a negative UA. Do I still need to charge for that or is that included in a well woman exam?
  12. M

    Wiki Vag twin delivery

    What would I need to code for twin delivery and insurance is Medicaid. How do I code this since it is a fee for service? Thanks!
  13. M

    Wiki Laparoscopy

    I'm unsure how to code this surgery it was a Operative Laparoscopy with fulguration with endometrial implants. Any ideas?
  14. M

    Wiki UPT for initial visit

    I have a patient that is global, I charge for the UA but I've never charged for the UPT. Can anyone let me know? Do I need to start charging for it on the fee for service patients too?
  15. M

    Wiki Destruction of Lesions

    I'm trying to code a destructions of lesions code. The doctor coded it as a 17110 but the description says "2 warts left side of perineal body. TCA applied". Do I need to send this back asking, for size and method? Thanks!
  16. C

    Wiki Billing for Hydration in Labor Check and Call

    Hello I have a scenario I need help with. I have a billing area that's a clinic that sees patients in labor check and call sometimes for things like false labor they are billing CPT 96360 and 96361 when they either bill and E/M or NST. I was removing the iv hydration because I think it should...
  17. G

    Wiki Does anyone code for Medicaid of WA RHC?

    We are an RHC and we are having issues getting OB claims processed by MA WA. Biggest issue at this time is MA WA does not accept our billing of high risk DX codes and only wants to pay on normal pg DX codes. ????? Any help or pointing to references that actually can help would be greatly...
  18. buskeys

    Wiki Modifier FP

    What situations can you use mod FP in? Guidelines? I am having a hard time finding a straight forward answer.
  19. S

    Wiki Commercial and Medicaid Maternity Billing

    Hello, We often have patients that have commercial insurance with Medicaid primary for all of their maternity care. If the patient meets the requirements for a global delivery we will bill the global delivery but in this case the patient doesn't have maternity coverage with her commercial...
  20. E

    Wiki CPC Experienced remote OBGYN/Midwifery and Orthopedic coder seeking Part time remote

    I am a Certified Professional Coder through AAPC with a Coding and Billing Specialist Certification through USCI. I am currently seeking a part time remote position and I am willing to code for different specialties. I have experience coding for not only OBGYN/Midwifery and Orthopedics, but also...
  21. D

    Wiki Billing cystourethroscopy during the global period of a hysterectomy

    The patient has a hysterectomy (code 58571) for a fibroid uterus and adnexal mass. A couple months later the patient came back and had a cystourethroscope for cystitis with the global period of the hysterectomy. Should I use modifier -58 for billing or -79?
  22. KatieBrownCPC

    Wiki HELP Well woman Prev Visit vs Office Visit coding

    Need to understand when to code for Prev Visit and When to stick to new patient, all the ICD vs CPT feel backwards from primary diagnosis to visit billed ...TIA New Pt 36 Here for well woman with pap, STI and HIV ICD consists of Z11.3 STI screen Z11.4 HIV screen Z01.419 GYN routine exam...
  23. C

    Wiki Z34.- vs Z36.-

    Can someone please provide me with some more information regarding the use of Z34.- (Encounter for supervision of normal pregnancy) versus the use of Z36.- (Encounter for antenatal screening of mother), and when it would be appropriate to assign on versus the other? I cannot seem to find...
  24. C

    Wiki Z34.- vs Z36.-

    Can someone please provide me with some more information regarding the use of Z34.- (Encounter for supervision of normal pregnancy) versus the use of Z36.- (Encounter for antenatal screening of mother), and when it would be appropriate to assign on versus the other? I cannot seem to find...
  25. C

    Wiki Z34.- vs Z36.-

    Can someone please provide me with some more information regarding the use of Z34.- (Encounter for supervision of normal pregnancy) versus the use of Z36.- (Encounter for antenatal screening of mother), and when it would be appropriate to assign on versus the other? I cannot seem to find...
  26. C

    Wiki Z34.- vs Z36.-

    Can someone please provide me with some more information regarding the use of Z34.- (Encounter for supervision of normal pregnancy) versus the use of Z36.- (Encounter for antenatal screening of mother), and when it would be appropriate to assign on versus the other? I cannot seem to find...
  27. A

    Wiki Diabetic counseling for OBs - payment outside the global package?

    I've researched this quite a bit on the internet and AAPC forum. I'm hoping to find out if there is an OBGYN clinic who has been successful at receiving additional reimbursement for Diabetic counseling to an OB patient. Our OBGYN clinic would like to institute diabetic counseling to diabetic...
  28. R

    Wiki Gestation diabetes during post partum period

    I am not really familiar with OBGYN, but I have a provider who is coding O24.415 - Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs. My issue is that this patient is 7 month postpartum, therefore I believe that this MD should not longer be using the O - code...
  29. K

    Wiki Obgyn mdm risks

    I'm curious to know opinions on risk for mdm for amenorrhea visits. patient has no health complications, mild nausea and work up is blood work,pap, and ultrasound at the next visit... could one argue that it is an [undiagnosed new problem with uncertain prognosis] since the ultrasound hasn't...
  30. B

    Wiki 58563 and 58558

    Good morning! We have had an OB/GYN to join our family practice. While we have coded and billed for deliveries (including c-sections) we have never had experience in coding and billing any other GYN surgeries. This morning, I came across a situation that I am fairly certain cannot be billed...
  31. R

    Wiki Experienced professional coder looking for part time (<20h/wk) remote

    I am an experienced CPC with over 15 years' experience. My coding experience ranges from primary care (Fam Med, IM, Peds), to specialties such as ID, OBGYN, and ED. My resume is attached. I am willing to work remotely up to 20 hours per week. My contact information is in the attached resume...
  32. K

    Wiki OBGYN Global vs. itemization question

    When we itemize out a patients antepartum care when they were seen less than 4-6 times, per coding guidelines, we would bill out an office visit per visit and any other services that were done at the time of service. Since global antepartum billing includes all services related to pregnancy...
  33. J

    Wiki OBGYN coder seeking REMOTE job

    I am seeking my first REMOTE coding opportunity. I am currently coding OBGYN, and have for 9 years, in a large private practice and have mastered all aspects of billing to include coding, claims, denials, payment posting, revenue cycle management, AR and collections. As project manager or team...
  34. K

    Wiki How to bill assistant surgeons- OBGYM

    Hey all, I am just needing verification how to bill an assistant at surgery.. my thoughts are either 59409,80; 59514,80; 59612,80; 59620,80 (depending on the situation/documentation). Any input is greatly appreciated. **actually just verified that the 80 modifier is only allowed on 59514...
  35. M

    Wiki NC Medicaid-85018

    My doctor wants cpt 85018 billed when performed for patients during pregnancy. These are denying for Missing/incomplete/invalid CLIA certification number. Not sure why because the CLIA is on the claim box 19. Any advice on getting these paid?? Any advice is appreciated! Thanks so much :)
  36. K

    Wiki Bundling question

    Hello, repeat C-section and drainage of right ovarian cyst.....would the 58822 be considered bundled in the 59510? I'm thinking it is billable with 51 mod (as a related procedure)? Thanks!
  37. K

    Wiki BCBS Medical Necessity Denial

    Hi All! Hoping someone can help me out. We have been put on prepayment review for BCBS which means we need to submit medical records for all codes billed with a Transvaginal sonogram. We have done so for all patients (2-3 page E&M, 2-3 page Ultrasound report). BCBS has constantly come back on...
  38. A

    Wiki Annual visits

    Good Afternoon, I am new the ob coding area. I have a provider who is doing the annual woman exam and does not do a ROS. Is this required for the ob visits? She does bill 993** codes. Thanks in advance.
  39. S

    Wiki 87481 Billed with multiple units HELP!!!! Insurance will only pay 1 unit

    We have been billing code 87481 with 4 units and the insurance companies are only paying for 1 unit. We have billed with and without modifier 91, w/mod 91 we got denial. Multiple Ins. companies are wanting to process only 1 unit. PLEASE HELP ME WITH THIS ISSUE!!!! CPT Code(s): 87481x4...
  40. D

    Wiki Part Time Experienced Biller for OB-GYN Practice in Montvale, NJ

    OB-GYN practice looking for experienced biller with coding experience. CPC strongly preferred and must be ICD-10 proficient. 10-15 hours per week. Hours are flexible and negotiable. The candidate must have strong knowledge of scrubbing claims and reviewing charges before submission for...
  41. C

    Wiki Uretheral laceration repair

    I have a patient who delivered her baby vaginally. She also had a 'uretheral laceration, sulcal laceration and episiotomy 2nd degree laceration repair. I know that 58300 must be done by a different MD (not in this case). I know that 56810 for sulcal repair is non-ob (also not in this case) -...
  42. D

    Wiki OBGYN Modifier 25 Question

    Can someone please help. Patient comes in with suspicion of being pregnant. OBGYN does the exam to determine pregnancy then does an ultrasound to determine viability. When billing if you don't use the 25 modifier on the e/m the ultrasound gets paid and the e/m gets denied as bundled. My...
  43. R

    Wiki OBGYN Observation Coding

    Our facility participates on a Residency Program which provides OBGYN teaching. Should an E/M observation code (99217-99220) be billed or E/M outpatient code (99201-99215) when the patient is on Labor and Delivery for 24 hours or less? Thanks.