This aspect of op note coding is the “horse that pulls the cart.”
Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.
Step 1: Itemize procedures.
Step 2: Assign CPT codes.
Step 3: Eliminate “standard” procedures.
Step 4: Eliminate bundled procedure that payers never pay (especially with Medicare).
Step 5: Bust bundled procedures that you know must be mistakes or are not reasonable. For instance, a vaginal hysterectomy with an anterior and posterior (A&P) repair is not a Correct Coding Initiative (CCI) edit, but some payers use a different edit program that may bundle these two. The reasons for the ob-gyn performing each service are different and distinct, so you should report these two procedures separately (even if you know a payer is trying to bundle them). Be prepared to appeal.
Step 6: List billable procedures in order of value (fee or relative value unit).
Step 7: Apply applicable modifiers (e.g., 59, 22, 52).
Step 8: Link each procedure to a justifying diagnosis. “This is the horse that pulls the cart,” Witt says. For instance, for an enterocele repair, you should have an enterocele diagnosis.
Order a CD of this session here.
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