OBGYN - PowerPoint PPT Presentation

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OBGYN

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Gynecology (GYN) Preventive medicine ... Gynecology (GYN) (cont. ... Gynecology (GYN) (cont.) Office procedures. Colposcopy. Endometrial ... – PowerPoint PPT presentation

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Title: OBGYN


1
Chapter 10
  • OB/GYN

2
OB/GYN Dual Provider
  • Many women have their OB/GYN provider act as
    their primary care physician (PCP).
  • Coders must know if the patient is being seen by
    the PCP or the specialist for coding E/M services
    and collecting co-pays.

3
Subspecialties of OB/GYN
  • Review Table 10-1.
  • Many OB/GYN physicians treat and diagnose
    urogenital system problems.

4
Internal Female Reproductive Organs
  • Ovaries
  • Fallopian tubes
  • Uterus
  • Vagina

5
Internal Female Reproductive Organs (cont.)
6
External FemaleReproductive System
  • External genitalia (vulva)
  • Labia majora
  • Labia minora
  • Clitoris
  • Urethral orifice
  • Bartholins glands
  • Breasts

7
External FemaleReproductive System (cont.)
8
Obstetrics (OB)
  • Treats pregnant women from conception through the
    puerperium
  • Services include maternity care for the healthy
    patient (or one with complications), childbirth,
    and postpartum care for the mother
  • CPT 59000 code series, including abortion

9
ICD-9-CM Guidelines
  • Pregnancy codes from Chapter 11 are sequenced
    first except when the patient has HIV
  • Must know reason for encounter
  • V codes for asymptomatic patient, high risk HIV
    group, and counseling

10
ICD-9-CM Guidelines (cont.)
  • Impending or threatened conditions
  • Chapter 11 codes (630677) are placed on the
    mothers chart only
  • V22.2x for a routine prenatal visit with no
    complications
  • V23.x for high-risk prenatal visit

11
ICD-9-CM Guidelines (cont.)
  • Principal diagnosis for delivery
  • V27.0V27.9 for each delivery
  • 655 codes are assigned only if a fetal condition
    is affecting the mother, such as surgery on fetus
    in utero

12
ICD-9-CM Guidelines (cont.)
  • 648.0x is assigned for pregnancy with diabetes
    followed by a code from 250.0x. Use V58.67 if
    treated with insulin.
  • 650 is only assigned to a normal delivery with no
    other codes as secondary.

13
ICD-9-CM Guidelines (cont.)
  • Screening
  • Observation
  • Aftercare
  • Follow-up
  • Postpartum
  • Counseling
  • Family planning

14
Maternity CPT Package
  • Antepartum, delivery, and postpartum services are
    all included in one payment!
  • Initial and subsequent history
  • All physical examinations
  • BP and weight recording
  • Fetal heart tones
  • Urinalysis

15
Maternity CPT Package (cont.)
  • Monthly visits up to 28 weeks
  • Biweekly visits up to 36 weeks
  • Weekly visits until delivery

16
Maternity CPT Package (cont.)
  • Delivery
  • Including admission, management of labor,
    episiotomy, and use of forceps
  • Normal hospital and office visits for 6 weeks
    after delivery

17
Maternity CPT
  • Any medical problems complicating delivery should
    be coded separately with E/M

18
Maternity CPT (cont.)
  • More than one provider may see the patient during
    this 10-month period.
  • Use the appropriate code to indicate what portion
    of the antepartum, delivery, and postpartum care
    was given (5940959410, 5941459430)

19
Obstetrical Complications
  • Code for obstetrical complication is sequenced
    first
  • Anemia, gestational diabetes, hydramnios, toxemia
    (pre-eclampsia), placenta previa, ectopic
    pregnancy, multiple births, etc.

20
Obstetrical Complications (cont.)
  • Select E/M codes or procedure codes in addition
    for complications during antepartum or delivery

21
Abortion
  • Therapeutic (TAB)
  • Elective
  • Spontaneous (SAB)

22
Services Separately Coded in Maternity Care
  • Ultrasound
  • Amniocentesis
  • Special screenings for genetic conditions
  • Unrelated pregnancy conditions
  • High-risk illness services

23
Gynecology (GYN)
  • Preventive medicine services (well woman exam)
  • Screening versus diagnostic Pap smears
  • Screening pelvic examination
  • CMS requires G codes for exams and Q code for Pap
    smear

24
Gynecology (GYN) (cont.)
  • Contraception
  • Infertility
  • Treatment of sexually transmitted diseases (STDs)

25
Gynecology (GYN) (cont.)
  • Office procedures
  • Colposcopy
  • Endometrial biopsy
  • DC
  • Cryosurgery
  • Removal of lesions of external genitalia

26
Surgical GYN Procedures
  • Exploratory laparotomy
  • Laparoscopy
  • Vulvectomy
  • Colporrhaphy
  • Colposcopy with loop electrode of cervix
  • Myomectomy
  • Hysterectomy

27
Surgical GYN Procedures (cont.)
  • Insertion of IUD
  • Hysterosalpingoophorectomy
  • Hysterosalpingography and chromotubation
  • Hysteroscopy
  • Ovarian cystectomy
  • Cystocele/rectocele repair
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