Coding Reimbursement Tactics for Well-Woman Exams
Published on Wed Apr 01, 1998
The annual preventive well-woman exam is one of the ways a progressive ob/gyn practice promotes the health of its patients. But according to Jan Rasmussen, CPC, a coding consultant and instructor for Med-Learn, a medical practice management training and consulting firm, proper coding for these preventive medicine services can be challenging. Part of the challenge is that these services fall into the preventive medicine codes and are separate and distinct from the disease-oriented codes. The problem is that very often, the well-woman exam encompasses more than just an exam. Here is a review of various well-woman exam scenarios and some tips on how to code for them to increase your chances of being adequately reimbursed.
1. A straightforward preventative medicine service. In this situation, a woman makes an appointment for a preventive exam strictly because it is time for her check up and she wants to insure her health and stay disease-free. When making the appointment, she offers no complaints, comes in as scheduled, and the exam goes as planned. The physician obtains a comprehensive history and performs a comprehensive exam including a pelvic and breast exam. The CPT codes used in this case are the Preventive Medicine Services codes 99384-99387 for new patients and 99394-99397 for established patients. These codes are linked to the ICD-9 diagnosis code V72.3, the code used for a gyn exam with or without a Pap smear. This diagnosis code is only to be used with preventative medicine codes and never with office visit codes.
Tip: Some women who are healthy and free of disease symptoms let years pass between exams. If a patient has not received any professional service from you or a member of your group (within the same specialty) for three years, you can consider her a new patient.
2. Exam with counseling. Despite the lack of disease, few well-woman exams are without some counseling and discussion between patient and provider. Consider the situation in which a woman comes in for a preventative exam and everything goes as above, except since her last visit, the woman has experienced a lifestyle change and has some questions for the physician. The physician spends 15 minutes beyond the normally allotted time counseling her about birth control, disease risks and disease prevention.
Can you code for this extra time? Rasmussen says, absolutely not. These sorts of activities, according to the CPT, are already included in the Preventive Medicine Services codes. These services include counseling/anticipatory guidance/risk factor reduction interventions that are performed on the same day as the examination and are not billable as separate services. They are viewed as part of prevention.
Tip: If a patient has a significant issue that needs extensive preventive counseling or discussion, make a [...]
