Auditing Obstetric and Gynecologic services requires more than verifying whether a CPT code appears supported by medical record. The Certified Professional Medical Auditor must connect medical documentation, diagnosis, medical necessity, services performed, bundling rules, modifiers, and/or payer policy requirements. In OB/GYN auditing, details matter! From trimester and weeks of gestation to whether a separately reported E/M service represents work beyond another service.



Pregnancy Changes the Coding Framework

One of the first questions in an obstetric audit should be: Does the diagnosis coding accurately reflect the pregnancy and the condition being managed?

Under the ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 15 codes (O00–O9A) have sequencing priority over codes from other chapters when applicable. Additional codes may be assigned when necessary to further identify the condition.

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