Due to the significant changes in how medical billing is coded, it’s essential to keep up with current coding tips to help protect your practice and avoid claims denials. Denials for procedures hit 17% in 2021, with even higher rates in hospitals.
One of the most significant contributors to OBGYN LTD’s claim denials is incorrect or incomplete coding. This can harm long-term disability claims, in particular.
Before we dive deeply into the issue, let’s drive through Acronym City for posterity’s sake and quickly go over what each one stands for.
Acronyms Ahead
As we mentioned above, let’s quickly review some of the acronyms you will encounter in this article.
- OBGYN – Obstetrician/Gynecologist
- LTD – Long-Term Disability
- CPT – Current Procedural Terminology
- HCPCS – Healthcare Common Procedure Coding
- ICD-9 – International Classification of Diseases
Okay, that should cover most of them. Read on if you’re still here and curious about how CPT codes can affect OBGYN LTD claims!
How CPT Codes Affect OBGYN LTD Claims
CPT codes account for a large amount of the payment process in getting any medical procedure claim paid, denied, or at least on a path toward one or the other. Hopefully, this brief article will cover everything that you need to know.
How CPT Codes Can Help Get Your OBGYN LTD Claim Paid Faster
CPT Codes can help get your OBGYN LTD claims paid faster if you use the correct codes the first time. Pretty straightforward, right? Not so much.
A specific diagnosis will typically get the claim delivered faster. In reality, it depends on how you decide to code it. If you use signs and symptoms coding, it can take longer to get the claim paid, especially for a long-term disability claim.
Unfortunately, just because the claim gets paid faster doesn’t always mean that the diagnosis is in the patient’s best interest. As you’re aware, specific diagnoses in the OBGYN can be exceedingly tricky without repeated visits. Even then, there is a possibility of the need for palliative care – hence long-term disability.
Staying on top of the latest changes and dedicating serious time to studying CPT codes or training a staff member is the best way to ensure that your claim gets paid on time and that you avoid claims denials as much as possible.
How To Choose The Right CPT Code For Your OBGYN Procedure
As we reviewed above, choosing the right CPT Code is the key to ensuring that OBGYN LTD claim denials are few and far between at your practice.
As with many issues in the medical world, Continuing Education Courses in medical coding through organizations like AAPC can be a significant benefit in keeping up to date on the latest changes and other news from the OBGYN medical coding world.
Still, choosing the correct code can be complex and frustrating at times. Depending on the specific ICD-9, the percentage can vary by a wide margin. The insurance company will deny the claim if the diagnosis code doesn’t match the procedure.
Modifiers to coding can also be equally as significant when it comes to OBGYN LTD claim denials. For example, if anesthesia is given, adding the -47 modifier is crucial to getting the correct amount from the insurance claim. For instance (admittedly outside the OBGYN realm), a broken toe will not warrant an ultrasound, so insurance will not pay that claim.
How CPT Codes Can Affect The Amount Of Your OBGYN LTD Claim
CPT codes work hand-in-hand with the American Medical Association to determine the type of procedure(s) a patient undergoes. While it may seem confusing, the AMA has a system in place – half the battle.
Ultimately, the amount of the payout for reimbursement on an OBGYN procedure or diagnosis will depend on the vital role that a CPT code plays. It will be challenging to avoid claim denials if you don’t have a medical coding service or know the updated medical coding procedures.
Another primary concern is the allowable “percentage” of time you report regarding your patient’s treatment. For example, if you spend 75% of your time in “diagnosis” mode and 25% in “treatment” mode, the CPT codes will vary by quite a wide margin.
This can certainly seem like over-governance of any everyday practice. That is why there are law firms that assist with ironing out the confusion of why an OBGYN LTD claim denial was the insurance provider’s initial response.
Some third-party medical coding businesses will do the work for you, your hospital, or your practice. However, with the rising amount of denials in recent years, many private courses are turning to the option of doing their medical coding.
The Difference Between HCPCS Codes And CPT Codes For OBGYN
Here’s where things may get confusing. We warned you that there would be a lot of acronyms. HCPCS codes are used in conjunction with and as a supplement to CPT codes.
HCPCS codes are used chiefly (though not exclusively) by Medicaid and Medicare providers. If a drug is administered onsite (as opposed to via pharmacy), an HCPCS code will often be needed.
For instance (again, hypothetical and outside of the OBGYN realm), let’s say that a patient presents with extreme flank pain and an inability to urinate and is found to have a kidney stone that requires surgery. Since the patient is in excruciating pain, the doctor decides to administer intravenous painkillers before a catheter is inserted and the surgery is performed.
The person in charge of your medical coding should use a CPT code for the diagnosis, the surgery, and the catheter, along with the insertion of the IV. They should then check the HCPCS codes before checking CPT codes for getting the painkillers covered by insurance.
While this is not a long-term disability example, it is a basic breakdown of the difference between HCPCS codes and CPT codes that someone in the OBGYN field can understand and translate to their practice. You can then apply them to your area and practice accordingly.
Claim Denial Wrap-Up
As referenced above, 17% of claims submitted for reimbursement by private practices are denied. To avoid claim denials, accuracy and continuing education are vital factors. Staying up to date on coding trends (or paying someone else to do so) is very important.
To maintain an efficient practice – as with any business – you or someone in your employ should closely watch federal or state policy changes.
A messy medical coding system is the fastest route to OBGYN LTD claim denials.
CPT codes should be one of the main concerns for your billing process, and it’s easy to see why. While it’s far from perfect, consistency across several different states, practices, medical procedures, and treatments is a wild request within the current medical care climate. The AMA made the system for a reason.
Medical billing is not a fun or simple process. However, with the advent and implementation of some sound continuing education policies within your practice, you can avoid claim denials to a much higher degree.
OBGYN LTD Claim Denials
As a healthcare provider, you no doubt understand the need for reform in the medical billing process. It can be particularly heartwrenching for someone who needs long-term disability because of a reproductive issue.
OBGYN LTD’s claim denials can no doubt rip the heart out of any practicing physician. It’s not about compensation, per se, but a business has to be a business at some point to stay afloat. While some issues will undoubtedly and unfortunately slip through the cracks because of red tape, you can still ensure that you are covered to continue caring for patients.
Making sure that insurance companies adequately reimburse you doesn’t make you greedy. It makes you a responsible healthcare provider that intends to stay in business to keep caring for others. You can do so by shoring up any issues with your CPT codes.
Our firm has locations throughout the Massachusetts area. If you’d like to read testimonials from former clients about what we were able to do for them, please read on.
Please contact us if you find yourself or your practice struggling more than anticipated with this complicated issue. We specialize in long-term disability denials and are well-versed in medical coding errors.
