Top 5 Medical Billing Denial Reasons in Ob/Gyn Practice

Posted by: Alok Prasad

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Ob/GYN Billing Denial Codes

Compared to more commonly processed claims in pediatrics, rheumatology and other branches of medicine, OB/GYN practitioners find themselves facing an alarming percentage of insurance denials often nearly double that of other practitioners. In this post, we'll discuss which CDT codes are most often denied according to a report from RemitDATA, what reason is most commonly given for them and how to avoid having claims with those codes denied.

It should be noted that implementing medical records systems that help reduce errors or make it easier to view claims with a problematic code help reduce denials. Recent articles on electronic health records systems by both Information Week and Med City News pointed to reduced errors, ease of searching and discovering patterns in denials and increased patient interaction.

99000 - Specimen Handling Office/Lab

Whether the lab is across the street or across the country, code 99000 refers to expenses that are incurred in transporting a specimen to a lab, such as time, fuel, mileage, postage or using a courier service, this would be an appropriate code. If it doesn't incur significant costs, you'll see denial code 97: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

99213 - Outpatient Doctor Visit, Level 3

You have a routine office visit with your patient and use a routine code, 99213, to bill it. Unfortunately, too many practitioners use this code as a one-size-fits-all generic code, causing it to be the most commonly denied code with a reason code of 18, duplicate claim or service. By definition, a level three visit has to be in depth enough to make medical decisions of low complexity. If you're doing more than that, you should brush up on other codes for common issues.

81002 - Urinalysis Non-Automated W/O Scope

Code 81002 tends to be a catch-all for basic urinalysis procedures whether for ketones, biliruben or glucose. Whatever the test was for, adding a modifier code often helps you avoid denial code 16: Claim lacks information or has errors.

36415 - Routine Blood Capture

You would think that billing a procedure that involves sticking a needle in someone's arm and collecting the blood from it would be pretty commonplace, right? Yet routine blood capture is the third-highest denied code, often due to not being paid separately, reason code 234.

99214 - Outpatient Doctor Visit, Level 4

By comparison, 99214 requires decision making that is moderately complex and often requires testing to decide the best possible treatment for your patient. If you had to talk to your patient about their new medication in depth because they don't understand the difference, it's a level 3 visit. If you're prescribing a new medication based on an in-depth interview, testing and above-average research, it's level 4. This is why reason code 96, non-covered charge(s), is the most common denial.

In addition to the above suggestions, putting appropriate coding and documentation procedures into place in your practice also help lower denials significantly. A recent University of Mississippi Medical Center slide show presents a number of excellent suggestions for lowering denials through better office procedures, including suggestions on the upcoming changeover from ICD-9 to ICD-10.

At RevenueXL, our commitment is to help you provide the best possible care to your patients through electronic medical records designed specifically for OB/GYN practitioners, strategies to avoid insurance denials and professional outsourced medical billing, keeping you taking care of people instead of chasing insurance companies.

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