EM Coding Alert

Question: We had a 44-year-old come in to see her physician for her wellness visit (99396).  She wanted a female to do the pap, but only had male providers in the office on the day of her visit. So she scheduled a pap for a week later with one of our female family practice physicians. Can we bill another 99396 for the pap? 

Iowa Subscriber

Answer: Bill 99396 (Periodic comprehensive preventive medicine reevaluation and management …) with the V72.31 (Routine gynecological examination) diagnosis for the future visit and use a V70.0 (Routine general medical examination at a health care facility) for the first exam may be the most appropriate coding for these encounters.

The female family practice physician would probably not get paid for the pap on the second visit with only a diagnosis of V72.31 and 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and a straightforward medical decision making ...). 

A physician won’t likely just collect the specimen without an examination and she will want to check the areas that relate to a wellness visit for the patient. Check the provider’s documentation to see what was actually done.

Helpful hint: Your practice may find it beneficial to help your patients understand the implications of going to two doctors to accomplish one service.