Gynecology Medical Billing

Knowledge makes all the difference

Gynecology in Medical Billing

Many Obstetrics & Gynecology practices find solace in outsourcing their billing services, recognizing the inherent benefits it offers. By entrusting experts with specialized experience in Obstetrics & Gynecology coding and billing, practices can mitigate the risk of errors and streamline the arduous process of claims submission. Due to gynecology medical billing, not just outsourcing becomes convenient but it also ensures the strategic financial health of the practice.

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Obstetrics & Gynecology Billing

Medical billing and coding guidelines contain precise key points that medical billers and coders, particularly those working in urgent care billing centers, must adhere to. Staying updated on these guidelines is essential to ensure accurate coding of medical billing services. These guidelines hold significant importance for urgent care centers as they aid in ensuring patients receive rightful reimbursement while preventing overpayment by healthcare providers and ensuring the strategic financial health of the practice.

Accurate Coding

Timely Submissions

Denial Management

Increased Revenues

Reimbursement Rate

Timely Follow-ups

1. Evaluation and Management (E/M) Codes

99202-99215:
 These codes are used to bill for office visits, ranging from a brief problem-focused visit to a comprehensive visit. These codes take into account factors such as the complexity of the patient’s medical history and the level of medical decision-making required.
99384-99387: These codes are used for annual wellness visits for new patients, ranging from a comprehensive preventive evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, new patient; 18-39 years old, including counseling/anticipatory guidance/risk factor reduction interventions.
99394-99397: These codes are used for annual wellness visits for established patients, ranging from a comprehensive preventive evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, established patient; 18-39 years old, including counseling/anticipatory guidance/risk factor reduction interventions.
99401-99404: These codes are used to bill for preventive counseling and risk factor reduction interventions, such as contraceptive counseling or counseling for sexually transmitted infections.
81025: This code is used for a urine pregnancy test.
88164-88167: These codes are used for cervical cancer screening tests, such as a Pap smear.

2. Surgery Codes
Surgery codes are used for surgical procedures, such as hysterectomies, laparoscopies, and dilation and curettage (D&C) procedures. They are categorized based on the type of procedure and the approach used, such as vaginal or abdominal.

Following are some examples of surgery procedure codes related to gynecology:
Hysterectomy: CPT code 58150. This code is used for a total abdominal hysterectomy, including the removal of the uterus and cervix.
Laparoscopic Hysterectomy: CPT code 58570. This code is used for a laparoscopic total hysterectomy, including the removal of the uterus and cervix.
Oophorectomy: CPT code 58956. This code is used for a unilateral (one side) oophorectomy, which is the surgical removal of an ovary.
Salpingectomy: CPT code 58700. This code is used for the surgical removal of one or both Fallopian tubes.
Endometrial ablation: CPT code 58353. This code is used for the destruction of the uterine lining (endometrium) using various techniques, such as thermal ablation or radio frequency.
Myomectomy: CPT code 58140. This code is used for the surgical removal of uterine fibroid.
Cervical biopsy: CPT code 57421. This code is used for the removal of a small amount of tissue from the cervix for examination.

3. Radiology Codes
Radiology codes are used for imaging studies, such as ultrasounds and mammograms. They are categorized based on the type of imaging study and the area of the body being studied.

Common radiology codes related to gynecology include:

Transvaginal Ultrasound (76830): This code is used to describe an ultrasound exam of the female pelvis, including the uterus, cervix, and ovaries. It is commonly used to evaluate conditions such as uterine fibroid, ovarian cysts, and endometrial cancer.
Hysterosalpingography (74740): This code is used to describe an X-ray procedure that evaluates the uterus and Fallopian tubes. It involves the injection of a contrast dye into the uterus, followed by X-ray imaging to evaluate the flow of the dye through the reproductive tract. This procedure is commonly used to evaluate infertility and to diagnose conditions such as blocked Fallopian tubes.
Magnetic Resonance Imaging (MRI) Pelvis (72195): This code is used to describe an MRI scan of the pelvis, including the reproductive organs. It is commonly used to evaluate conditions such as ovarian cancer, endometriosis, and pelvic inflammatory disease.
Computed Tomography
(CT) Pelvis (72193):
 This code is used to describe a CT scan of the pelvis, including the reproductive organs. It is commonly used to evaluate conditions such as ovarian cancer, uterine fibroids, and pelvic inflammatory disease.

4. Laboratory/Pathology Codes
Laboratory/pathology codes are used for laboratory tests and pathology studies, such as pap smears and biopsies. They are categorized based on the type of test or study being performed.

Following are some common laboratory/pathology procedure codes related to gynecology:

Pap smear (88141, 88142, and 88143): These codes are used to report the collection and interpretation of cervical or vaginal smears for the detection of abnormal cells.
HPV testing (87624, 87625): These codes are used to report the testing for the human papillomavirus (HPV) in women.
Chlamydia and Gonorrhea testing (87491, 87591, 87850, and 87800): These codes are used to report the testing for sexually transmitted infections (STIs) chlamydia, and gonorrhea.
Pelvic ultrasound (76856): This code is used to report an ultrasound examination of the female pelvic region, including the uterus, ovaries, and fallopian tubes.
Endometrial biopsy (58100, 58110, and 58120): These codes are used to report the collection and interpretation of a sample of tissue from the lining of the uterus for diagnostic purposes.
Hysteroscopy (58555, and 58558): These codes are used to report a diagnostic or surgical procedure that involves inserting a thin, lighted tube through the vagina and cervix to examine the uterus.

5. Medicine Codes

57420: Colposcopy of the cervix, including biopsy of the cervix or endocervical curettage
58300: Insertion of intrauterine device (IUD)
58301: Removal of the intrauterine device (IUD)
58661: Laparoscopy, surgical; with the removal of adnexal structures (including tubes or ovaries)
58563: Hysteroscopy, surgical; with the removal of leiomyomata (fibroids)
58605: Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
58558: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C
58555: Hysteroscopy, surgical; with the removal of impacted foreign body
58970: Fetal monitoring, non-stress test
57454: Colposcopy of the vulva; with biopsy
57460: Colposcopy of the vulva; with destruction of lesion(s) by any method.

Case Study of Gynecology Procedures:

Correct Coding and Electronic Submission of Podiatry Claims aids in the reduction of denials and improvement in collection. For the success of any organization or system analysis is very important; through analysis, a system sees points where they are lacking and what factors are leading to a decrease in collections. Bad quality scanning of super bills and lack of adoption of electronic claims submission creates a charge backlog situation which results in increased denials on account of timely filing dates not being adhered to.

Challenges:

1. Communication Gaps among billing staff, physicians, and administrative.
2. Incomplete or inaccurate documentation from physicians.
3. Manual Data Entry.
4. Keeping up with constantly changing billing regulations and compliance.

Solutions:

These challenges could be solved by implementing a few new things and replacing old ones such as:

1. Communication enhancement.
2. Improvement in documentation practices among physicians.
3. Automation of billing process.
4. Education and Training of staff on using new software and ways to keep constant billing and maintain regulation of compliance.

Scenario of Denial:

Denial occurs when an insurance company refuses to pay for a medical service, leaving the provider unpaid for their services. This scenario of denial can have significant repercussions, affecting both the provider’s revenue stream and the patient’s access to necessary care.

Reasons:

1. Insurance coverage issue of patients.
2. Inaccurate or incomplete information provided by patients during the billing process.
3. Failure to comply with regulatory requirements.
4. Improper coding.

Solutions:

These challenges could be solved by implementing a few new things and replacing old ones such as:

1. Providers must ensure thorough and accurate documentation of patient encounters.
2. Billing Staff’s Training and Education.
3. Utilization of Technology.
4. Establishing an efficient appeals process to challenge denied claims is crucial.

Conclusion

The scenario of denial” in medical billing is a multifaceted challenge that requires attention to detail, adherence to regulations, effective communication between providers and payers, training of staff, latest technology. By implementing proactive strategies and leveraging technology; healthcare providers can mitigate denial risks and ensure timely reimbursement for their services, ultimately supporting the delivery of quality patient care.

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