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Discussion in 'Ob/Gyn' started by Dr G Oogle, Jan 11, 2019.
anyone have any tips about optimizing billing when starting in practice, especially @anonperson
At the PFD week, there is a coding workshop which I found to be helpful. Usually Marc Toglia runs it. I found this to be helpful for in office coding.
E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213 is also another helpful resource I use from time to time.
You will also end up using some of the time based coding as well (especially when counseling patients pre operatively, mesh consenting can take awhile) so use the time based coding when needed in order to get fairly compensated for your work in the office.
At least for urogynecology, procedural reimbursement for in office procedures can make a substantial portion of your revenue so making sure you can maximize this is important.
Properly coding for urodynamics (bladder pressures, abdominal pressures, EMG, etc) and cystoscopy (diagnostic or doing botox). You can find info on the AUGS practice management section and the AUA website
For the OR, making sure you use the following codes as appropriate:
57410- pelvic exam under anesthesia.
For example, if I am performing a TVH, USLS, etc I am performing a pelvic exam at the beginning of the case to better assess the prolapse and anatomy that needs to be corrected. I am using this fairly routinely and I have not had any issues regarding reimbursement for this. Its only 1.75 RVUs , but over the course of a year, it is money you don't want to lose.
Do not underestimate the difficulty of the cases your are doing. If a patient is significantly obese, or there are adhesions, or the prolapse is stage 4 etc, using this code will potentially add additional compensation. I typically dictate a section in my operative report and just call it "Modifier 22" and dictate what exactly made this case difficult (adhesions, etc) and the additional time added to the case (30 min etc) and how it required my expertise in order to safely perform the procedure. Again, on an individual basis it isn't a lot, but adds up over the course of year.
Making sure you properly code your surgical cases is important.
For example, if you are removing a sling for obstruction, coding for the sling removal/revision and the urethrolysis and the pelvic exam under anesthesia etc.
Touching base with your coders from time to time is important as well.
Thanks! Can you use a 57410 for non vaginal cases; for instance I do at least 50% of my primaries as robotic scp but still do an eua to assess the gh to determine if I’ll need to do a perineorrhaphy; granted I can usually tell in the office for I’ve had more than a few where I eneded up doing a PR because of the eua
Thanks for the reseource links!