COBGC Compliance and Documentation 5

Question 1

Which Medicare administrative contractor (MAC) resource should an OB/GYN coder consult to confirm local coverage policies for a specific procedure?

Accepted Answer

Local Coverage Determinations (LCDs) from the relevant MAC

Answer

The AMA CPT codebook

Answer

The ICD-10-CM Official Guidelines only

Answer

The ACOG Practice Bulletins

Question 2

A gynecologist performs a laparoscopic hysterectomy and documents 'tolerated procedure well' as the entire operative note. A coder should:

Accepted Answer

Request a complete operative report before coding or claim submission

Answer

Code the procedure as documented since the surgeon performed it

Answer

Append modifier -52 to indicate incomplete documentation

Answer

Code an unlisted procedure code due to insufficient detail

Question 3

Under the Anti-Kickback Statute, an OB/GYN receiving compensation from a pharmaceutical company for speaking engagements is at risk unless:

Accepted Answer

The arrangement meets the requirements of the Personal Services safe harbor

Answer

The physician discloses the arrangement to patients

Answer

The payments are labeled as 'educational grants'

Answer

The pharmaceutical product is not on formulary

Question 4

For a hospital-based OB/GYN, which documentation requirement distinguishes a teaching physician's personal performance of a procedure from supervision of a resident?

Accepted Answer

The teaching physician must personally document their presence and key portions performed

Answer

A countersignature on the resident's note is always sufficient

Answer

Only the resident's attestation is required under ACGME rules

Answer

Medicare waives documentation requirements in teaching hospitals

Question 5

A claim for a routine annual GYN exam is denied with reason code CO-50 (not medically necessary). The most likely issue is:

Accepted Answer

The diagnosis code submitted does not support medical necessity for the service billed

Answer

The wrong CPT code was used for the preventive visit

Answer

The patient's deductible has not been met

Answer

The claim was filed past the timely filing deadline

Question 6

Which practice is considered 'unbundling' in OB/GYN coding?

Accepted Answer

Billing separate CPT codes for components of a procedure that CPT instructs should be reported with one comprehensive code

Answer

Billing a global OB package instead of individual services

Answer

Assigning multiple diagnosis codes to one procedure

Answer

Reporting modifier -25 on an E/M performed the same day as a procedure

Question 7

A patient's OB chart documents smoking status but no counseling was provided or documented. The coder wants to bill 99406 for tobacco cessation counseling. This would be:

Accepted Answer

Fraudulent—services must be performed and documented before they are billed

Answer

Acceptable because smoking status documents the medical necessity

Answer

Permissible if the physician verbally discussed it

Answer

Allowed because smoking is a universal risk factor in pregnancy