# physical exams and well woman exams



## jliving77 (Jun 18, 2014)

Can someone please explain to me how to handle billing for a patient who had a complete physical exam with their PCP but also, in the same year, had an annual gyn exam with a female provider who works in the same office? I usually don't run into this because the female dr is almost always the women's PCP but I have a case where on 6/9/14 the pt had her annual gyn exam and it was billed with V72.31 and a 99396 (as well as a 99212 -25 due to seperately identifiable conditions the dr evaluated, diagnosed and treated) but now on 6/18/14 she had a documented CPE done. The dr who did the CPE also evaluated a problem with her toenail and dx'd onychomycosis and rx'd medication. Can I change this from a CPE to a regular office visit due to the additional issue? 

And just for future reference, how do you handle billing for an annual gyn exam or a CPE if the pt went to another provider for one or the other in the same year? I seem to remember an article in the Healthcare Business Monthly magazine but can't remember what issue.

Thanks!
Jennifer Livingston CPC


----------



## ValerieBatesHoffCPCCPMA (Jun 18, 2014)

*Cpe/wwe*

"And just for future reference, how do you handle billing for an annual gyn exam or a CPE if the pt went to another provider for one or the other in the same year? I seem to remember an article in the Healthcare Business Monthly magazine but can't remember what issue."


PCP - CPE (Annual Wellness Visit)

Age appropriate preventative code w/ ICD9 codes - V70.0

OB - WWE (Well Woman Exam)

Appropriate E/M code (99212 - usually low level but based on documenation criteria) ICD9 codes - V72.31 (Breast/Pelvic Exam) & V76.2 (PAP)

(Patient will probably have to pay a Co-pay)

http://www.supercoder.com/my-ask-an-...-patient-40-64

I have known other coders to bill the same preventative code with a modifier 52.

"Some have attempted to use modifier 52 to denote reduced services when less than a comprehensive history and exam are performed during a preventive visit. This is inappropriate because modifier 52 applies to procedural services only. Preventive visits that do not satisfy the minimum requirements may be billed with the appropriate E/M office visit code."

http://www.aafp.org/fpm/2012/0700/p12.html


----------



## jliving77 (Jun 26, 2014)

valerie848 said:


> "PCP - CPE (Annual Wellness Visit)
> 
> Age appropriate preventative code w/ ICD9 codes - V70.0
> 
> ...


So are you saying that a WW exam can not be coded with 99385 (for example)? Since my female provider is also the patient's PCP and does an annual well woman exam she does (usually) throughly document all the points of a physical, we use a physical exam template in our EMR, and there is no other provider who would see the patient for this except in the rare cases that I explained above.
I could not open the links you shared. Are there any other references for the policy on this that you could point me to?

Jennifer L CPC


----------



## ValerieBatesHoffCPCCPMA (Jun 26, 2014)

*You can code a well woman exam as a preventative visit*

You can code a well woman exam as a preventative visit as long as the appropriate criterion was documented.

Components of a preventive visit

Preventive visits, like many procedural services, are bundled services. Unlike documenting problem-oriented E/M office visits (99201-99215), which involves complicated coding guidelines, documenting preventive visits is more straightforward. The following components are needed:

	A comprehensive history and physical exam findings;
	A description of the status of chronic, stable problems that are not significant enough to require additional work, according to CPT;
	Notes concerning the management of minor problems that do not require additional work;
	Notes concerning age-appropriate counseling, screening labs, and tests;
	Orders for vaccines appropriate for age and risk factors.

According to CPT, the comprehensive history that must be obtained as part of a preventive visit has no chief complaint or present illness as its focus. Rather, it requires a ?comprehensive system review and comprehensive or interval past, family, and social history as well as a comprehensive assessment/history of pertinent risk factors.? The preventive comprehensive exam differs from a problem-oriented comprehensive exam because its components are based on age and risk factors rather than a presenting problem.

I may have initially misunderstood your question, I was referring to when a patient is seen for their annual physical exam by their PCP but the preventative GYN exam portion is deferred for a specific reason (i.e. pt was menstruating or prefers OB female physician) and chooses to come back for a separate visit to obtain breast/pelvic/pap smear then you can proceed billing a problem oriented E/M service code because the visit would not satisfy the minimum requirements for a preventative service. 

Depending on the payer and the patient?s plans benefits, usually only one preventative visit yearly is covered. If two preventative visit codes are submitted within the same payment year the second is often denied. This is why most offices have their schedulers, nurses, and physicians verify that it has truly been a year and a day from there last CPE. 

I'm sorry about the links not working. Hopefully the ones I provided below this time will. I would check out AAFP, and CMS (Medicare Learning Network).

http://www.cms.gov/Outreach-and-Edu...twork-MLN/MLNProducts/PreventiveServices.html

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf

http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf

http://www.aafp.org/fpm/2004/0400/p49.html

http://www.askleslie.net/drup3/


----------

