Obstetrics|Gynecology - Articles

To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.

The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.

Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.

When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. The Centers for Medicare & Medicaid Services (CMS) will...

Preventive Medicine Topics Page Cervical Dysplasia Screening Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...

Preventive Medicine Topics Page Screening Gynecological Examination Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...

Preventive Medicine Topics Page Contraceptive Methods Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...

Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...

It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia) Code examples: O99.011 Anemia ...

First three antepartum E&M visits Laboratory tests Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828) Amniocentesis, any method (CPT codes 59000 or 59001) Amniofusion (CPT code 59070) Chorionic villus sampling (CPT code 59015) Fetal contraction stress test (CPT code 59020) Fetal non-stress test (CPT code 59025) External cephalic version (CPT code 59412) Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery E&M services which is unrelated ...

If a procedure such as an excision of a polyp took significant additional time, work, and effort, you could append modifier 22 (unusual procedural service) to add to your fee when using 58100 "Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)." If a coloposcopy is performed in conjunction, use 58110 in addition to the ...

If you are coding for endocervical curettage only, use 57505 "Endocervical curettage (not done as part of a dilation and curettage)." If an endometrial sampling (biopsy) was performed in conjunction with a colposcopy, use 57420 "Colposcopy of the entire vagina, with cervix if present," 57421 for "with biopsy(s) of vagina/cervix, or 57452-57461 for "colposcopy of the cervix including upper ...

If a mother uses alcohol or tobacco during pregnancy, be sure to assign O99.31 "Alcohol use complicating pregnancy, childbirth, and the puerperium." Document the time of the encounter (such as the trimester), during childbirth, or during the puerperium. NOTE: You also need to assign a secondary code from category F10- to identify manifestation of the alcohol use. The following ...

Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should first be assigned a code from category O24 (diabetes mellitus in pregnancy, childbirth, and the puerperium) followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4. Diabetes mellitus due to underlying condition: with proliferative diabetic retinopathy without macular edemaE08.3591 right eye E08.3592 left eye E08.3593 bilateral E08.3599 unspecified eye E08.36 with diabetic cataract with diabetic macular edemaE08.37X1 right eye E08.37X2 left eye E08.37X3 bilateral E08.37X9 unspecified eye E08.39 with other diabetic opthalmic complication with ...

It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia). Code examples: O99.011 Anemia ...