OBGYN Medical Billing

CPT code changes and the implementation of ICD-10 have caused OBGYN Medical Billing and coding difficult for many practices. Generally, each specialty has a different way of coding the patient’s symptoms. The particular ICD-10 codes for OBGYN finds little application in any other medical specialty. Keeping women’s health in mind, these codes are unlikely to appear at a cardiology office or an emergency room. ICD-10 codes are numerous and cover a wide range of specialties. However, OBGYN Medical Billing remains unique owing to these common ICD-10 codes that are useful for the physician’s practice.

ICD-10 codes most commonly used for OBGYN Medical Billing:

Z01.419: Encounter Routine Gynecological Examination Without Abnormal Results

This ICD-10 code describes a routine OB GYN appointment for a patient. According to the majority of industry experts, women between the ages of 21 and 29 should visit their gynecologist at least once a year. At the same time, women 65 and older do not require such screenings at all. Secondly, women aged 35 to 65 who have had negative Pap test results only need to obtain a new test every five years.

Z12.31: Encounter for Screening Mammogram for Malignant Neoplasm of The Breast

Regular screenings are crucial since 1 in 8 US women, or around 12.4% of them, will acquire invasive breast cancer throughout their lifetimes. Most OB/GYNs provide these checks as a standard component of checkups.

N80.9: Unspecified Endometriosis

Recently, the stigma associated with endometriosis has become something of a hot topic, with many medical practitioners and advertising efforts focusing on educating women about the conditions and encouraging them to speak out. People with this diagnosis might get counseling and pain treatment from doctors.

Z34.01: First-trimester encounter for supervision of first pregnancy

This code refers to a patient who has visited their gynecologist’s clinic for a checkup during the first trimester of pregnancy.

099.011: First-trimester anemia complicating pregnancy

The risk of anemia developing during pregnancy has been rising, particularly for people who already have it before becoming pregnant. Iron deficiency anemia, folate deficiency anemia, and vitamin B12 insufficiency are the three kinds of anemia associated with pregnancy. A patient’s provider can administer blood tests to help determine which version she has and recommend treatment accordingly

OBGYN Medical Billing
OBGYN Medical Billing

For certain patients, some OB/GYN care procedures are either unnecessary or excessively difficult. Owing to the complexity in OBGYN Medical Billing caused by these procedures, the majority of patients and providers would consider it inappropriate to include them in the Global Package.

Z30.018: Visit for initial prescription of another form of contraception

There are several different birth control options available in the market right now. The first code refers to an IUD that requires a medical expert to install. Traditional birth control methods frequently involve pills and injections, which may be given during an appointment and obtained as needed.

N97.9: Unspecified female infertility

10% of women between the ages of 15 and 44 struggle to conceive or maintain pregnancy. Female infertility can have a variety of reasons, and an OB/GYN can help identify and possibly treat the issue.

Z11.3: Encounter for testing for infectious with a predominately sexual mode of transmission

Syphilis, gonorrhea, and chlamydia rates have reached record highs, according to the CDC, following 4 years of growth. If a patient takes the time to schedule an appointment and be checked out, OB/GYNs are competent to screen for, diagnose, and treat STDs.

Three scenarios to follow ICD-10 codes in OBGYN Medical Billing:

Scenario: 1 

Let’s say that postpartum is the reason behind this patient’s appointment. She decides to see the doctor for OBGYN services to discuss birth control alternatives or strategies. In this scenario, the healthcare professional has to examine the patient’s past and provide the patient with information regarding birth control options or plans. The patient chooses to go with the hormonal intrauterine device (IUD). The healthcare professional then puts the order in for the device and recommends that the patient attend an appointment with a follow-up appointment to be fitted with the device. These codes must be charged outside of appointment codes for postpartum:

ICD-10 CPT codes:

99213 to 24: Unrelated assessment and management services provided in the postoperative term by the same doctor or another licensed health care provider.

DX ICD-10:

Z30.09: Consultation for additional general counseling and contraception-related guidance. (Mentioned as the primary DX code and the sequencing have done accordingly).

Z30.014: Consultation for the initial prescription of an intrauterine device.

Scenario: 2 

Let’s imagine a pregnant woman goes to her OBGYN physician for a routine checkup and describes the symptoms of virginal discharge with odor. After doing an exam, the doctor proposes collecting a culture for a wet prep before confirming the diagnosis of acute vaginitis. After informing the patient about bacterial vaginosis, the physician or other healthcare provider prescribes clindamycin for treatment. Outside of the codes for a regular prenatal visit, codes must be billed in the following manner:

It’s crucial to comply with all OBGYN Medical Billing and coding regulations while reporting maternity care procedures.

CPT ICD-10 codes: 

99213: Office or other outpatient visits for the assessment and care of a known patient, requiring at least two of the following three essential elements: A low-complexity medical decision-making process; an enlarged problem-focused examination; and an extended problem-focused history.

87210: Primary source with interpretation for a smear; wet mount for infectious pathogens (e.g., saline, India ink, KOH preps).

HCPCS Level II Q0111: Wet mounts, including preparing cervical, vaginal, or skin specimens (instead of 87210) for the wet prep.

DX ICD-10:

N76.0: Acute vaginitis (mentioned as the primary DX code, and the sequencing have done accordingly).

In the encounter note, the OB/GYN physician or professional should document the clinical information of the visit. Whenever the physician sees a patient diagnosed and treated for conditions or problems outside the global period but does not appear at an E&M service level, it’s important to inform the provider to correct the records.

Scenario: 3

Assume a patient arrives for a postpartum checkup. She has described the condition to the OB/GYN physician, including severe depression and a tendency for self-harm. Similar to the example given above, a doctor looks at the entire patient’s history to establish whether the patient has ever actually experienced behavioral health issues or if postpartum depression is the only cause of their symptoms. The OB/GYN physician will then recommend the patient see a psychologist before writing an antidepressant prescription for them. The patient then schedules a second consultation with the psychologist after receiving a referral from the referring practitioner. ICD-10 codes outside of the postpartum visit codes can bill in the following way:

ICD-10 CPT codes:

99214 to 24: 24 Office or other outpatient visits for the assessment and care of an established patient, requiring at least two of these three essential elements: a thorough history, a comprehensive review, and moderately complex medical decision-making

DX ICD-10:

F53.0: Postpartum depression (mentioned as the primary DX code, and the sequencing have done accordingly).

There are a few codes on which OB/GYNs can depend. Employ the top healthcare billing companies, who have the expertise to perform all the specialized chores, to handle your OBGYN Medical Billing and coding. Additionally, it would help in increasing reimbursement rates.

How Does NEO MD OBGYN Medical Billing Services Revamp OBGYN Practices Revenue?

NEO MD offers unparalleled OB GYN medical billing solutions across all 50 states in the US. Our billing services are customized to the physician’s specific needs and are compliant with the mandatory Coding guidelines for a smooth process of processing claims. We have more than 10 years of OBGYN Medical Billing experience and unique strategies that stimulated several-trembling revenue cycle management. In addition, Our Revenue Cycle Management services are updated regularly with solid CMS guidelines. 

Further, NEO MD provides the top OBGYN Billings MT Services in terms of cost and performance to support effective cash flow and revenue. We provide obstetrical billing services at a lower price with No Hidden Fees.

Let’s Schedule a Demo to learn more about how we can improve your medical practice management. Get us at! (info@neomdinc.com) or (929) 502-3636). 


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How Does NEO MD OBGYN Medical Billing Services Revamp OBGYN Practices Revenue?

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