How to Avoid Claim Denials in OB Gyn?

How to Avoid Claim Denial in OB GYN?

Some specialities in healthcare industry have exceptionally high denial rate. OB Gyn is, unfortunately, one of them. Denials are an every occurrence for most OB Gyn centers. If you are facing extreme claim denials in OB Gyn that are impacting revenue, here’s a look at several strategies you can use to avoid claims denials in OB Gyn and start improving revenue for your practice.

Stay up-to-date

One of the best way to ensure claims are not unnecessarily get denied so you can maximize reimbursements is to stay up-to-date on coding updates related to OB/GYN specialty. Within the past few years, several changes in CPT codes have been made, so it is important to stay up-to-date.

Avoid Most Common Claim Denials in OB Gyn

It helps to be aware of some of the most common reasons of OB Gyn denials so providers can avoid them. A Physician’s Practice report noted that in the past some of the top unexpected denials have included:

  • 99214: Outpatient doctor visit at a level 4
  • 99000: A specimen handling office-lab
  • 81002: Non-automated urinalysis without a scope
  • 99213: Outpatient doctor visit at a level 3
  • 36415: Routine blood capture

There are several different reasons that these denials occur. In many cases, they get a code OA 18 denial for a duplicate claim or service, while it’s often common that the claims are denied because the benefit for service was already included in the payment of another procedure or service.

OB Gyn ICD-10 Specific Tips

Most practices have made the transition to ICD-10, but there are still some helpful ICD-10 specific tips that OB/GYN practices need to remember.

  • Be careful when reporting an annual GYN exam: In ICD-10-CM, the code for an annual GYN exam is not included in Chapter 15. Instead, it’s located in Chapter 21.
  • Document the cause of pelvic pain, if known: As in ICD-9-CM, if OB/GYN specialists can identify the cause of any abdominal and pelvic pain associated with menstruation, they should document this information.

MedisysData is an expert in billing and coding for OB Gyn practices. Whether you are starting a new practice or you want to increase revenue for an existing practice, enquire today to find out how we can help you avoid common industry pitfalls and help you maximize revenue.

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