# Tricare, Mercy care, Care First preventive



## YOLANDAB (Dec 10, 2012)

Does anyone bill ob services using 99213-25 dx 401.1, 250.02,  Q0091-59 dx V76.2, G0101 V76.2, V76.10.   If we don't bill with modifier 59 attached to Q0091, Q0091 is bundled with the other services.  Is this appropriate billing?  Please any ones comment is appreciated.  Thanks.


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## mitchellde (Dec 10, 2012)

If this is a well woman whyare you billing a 99213 with the other dx codes?  If a pt presents for a well visit and has no complaints you cannot charge an office visit with pre exisiting diagnosis.  To go over pre exisiting diagnosis is part of the preventive.  You can perform the office visit in addition to the preventive only if the patient has a complaint they express.  They patient has to be the one to initiate the service.  The provider cannot initiate an office visit when the patient expresses the intent is wellness.  
If you will examine ICD-10 CM closely you will learn that this is not allowed with the diagnosis codes for the wellness encounters.
Thefore when doing a wellness visit you bill wellness.  If the patient has a complaint as well, for now it may be billed as a secondary issue with a visit using the 25 modifier.  The dx code for a well woman is V72.31 you do not add the V76.2 it is inclusive. and you do not use the V76.10 as you did not do a breast screening, that is for the mammogram.


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## suziem (Dec 10, 2012)

*Medicaer*

The well woman exam for a Medicare patient for the screening pelvic and clinical breast exam is G0101 with Dx code V72.31 (if there are no risk factors). 
If the provider performs a pap smear you would also report CPT code Q0091 Collection of screening pap smear.  You would use diagnosis code V76.2 with this code.

I attended an ACOG conference and this is exactly how they instructed us to report the well woman exam, again with no risk factors.

If a separate problem visit is addressed during this visit, the provider should have a separate note and use the modifier 25 appended to the E/M visit.
-Suzie Merino, CPC, COBGC


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## mitchellde (Dec 10, 2012)

you do not use dx code V72.31 with V76.2 it is inclusive.  Look in you ICD-9 Cm book you only add a code if it is a vaginal pap(V76.47 + V88.1)


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## YOLANDAB (Dec 11, 2012)

Anyone familiar with Tricare and Mery care billing.  Tricare covers a preventive exam, Pelvic and breast exam G0101, it only pays on the Q0091 with the 59 modifier. Mercy care only cover Q0091 or G0101. Mercy Care and Care First covers the Q0091 if modifier 59 is attached to Q0091. Preventive exams are not cover for patients ages  21 and over (arizona).  Mercy care does not cover dx V72.31, they want V76.2 or other appropriate dx. All three plans allow sick visit during a pap, breast and pelvic exam.  Pt always have other complaints, they usually try to get as much in during a visit.  My question is does anyone uses modifier 59 to get Q0091 paid.  Thanks


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## mitchellde (Dec 11, 2012)

I understand what you are saying.. but not every patient has a complaint when they come for a well exam.. and ICD-10 CM will prevent you from being able to code a complaint with a preventive.  Just because they do not cover the V72.31 does not mean it is an inappropriate code, it means it is not covered.  No I never use the 59 modifier to get the Q0091 paid.  And you cannot code the V76.2 with the V76.31 and if it is a well woman you cannot code the V76.2 instead.  The codes belong to the patient and must represent the patients reason for the visit and the providers documentation.


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