Know these Ob Gyn Billing Myths to Get to your Rightful Pay

While working for your ob gyn practice, you often face tough ob gyn billing and coding scenarios.

For instance if you want to ensure payment for evaluation and management services your physician performs within the global period of a surgical procedure, you must be well-versed with the fine points of modifier 24.

If you don't want to fall into the ob gyn billing trap, here are some modifier tips that'll help you steer clear of them all.

Myth: You can add modifier 24 to any service carried out in the post-op period

You should only add modifier 24 to a proper E/M code when an evaluation & management service takes place during a postoperative global period for reasons not connected to the original procedure. Modifier 24 lets the payer know that the surgeon is tending to the patient for a new problem.

Myth: A scheduled office visit negates use of modifier 24

You should not automatically think that you'd not be able to bill for a separate service using modifier 24 just because of the fact that a patient is slated for an office follow-up post-operative visit in connection to his surgery.

Myth: Do not use modifier 24 for postoperative services

When you report postoperative services to payers that follow CPT® guidelines, you will be required to add modifier 24 to the E/M code to point to the service that took place during the surgery's global period.

Myth: If you add modifier 24 there must be a new diagnosis

While a different ICD-9 diagnostic code might point to the fact that the evaluation & management service carried out in a global period was not related to the surgery, you don't have different diagnoses to add modifier 24 and to get payment for those services.

It's not important that the two services have different diagnoses. However it should be clear that the service is carried out to discuss results, prognosis and treatment choices that any work done related to the surgery is not used to aid the level of service billed.

Myth: Don't use modifiers 24 and 25 together

Sometimes you may come face to face with situations where you need to unite the forces of modifiers 24 and 25 to stay away from claim denials. You can use these modifiers on the same claim if you're seeing a patient for a totally new issue within the post op period, a procedure was done that same day, and the evaluation & management code is important and separately identifiable from the procedure.

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