Advanced Search

Ob-Gyn Coding Alert

Reader Question:

Well-woman Exam

Published on Sun Jul 01, 2001

Question: When a patient comes in for her scheduled well-woman exam but then complains of pelvic pain or other problems, can we bill a problem visit in addition to the preventive visit?
Florida Subscriber
 
 Answer: In virtually all cases, you cannot bill for both preventive and problem-oriented care during a well-woman visit. The rule stems from the CPT book -- the note under the preventive codes -- that was added due to Medicare rules for carving out. Whether you treat the complaint or not has nothing to do with it. You can carve out a problem visit only if a significant problem was documented. This means additional history and medical decision-making, something most physicians fail to document separately from the preventive care. Also, most payers see the two codes on the same date as double billing for essentially the same service. So the best rule is to decide which service predominated the visit that day -- preventive or problem -- and bill that only.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Ob-Gyn Coding Alert

View All