Wiki Annual Gynecology exam - 99381-99397

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jemimah crescentia

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Hi:

Rocking New year wishes to all,

Could anyone help me to find out the code for "Annual Gynecology examination" done in Office without any current signs and symptoms,

Did the preventive medicine codes(99381-99397) suits the above scenario?,

I think Medicare uses the code G0101 for well women exam(WWE).

Thanks in Advance,
Jemimah Crescentia, CPC
 
There's no specific code for annual gyne exam. If the provider is doing an age-appropriate preventive exam, use the 99381-99397, as indicated.
Medicare uses Q0091 for the pap, and G0101 for breast and pelvic, and they carved out these codes separate from the preventive visit, because they still do not cover a routine preventive exam, as coded by 993xx. If you bill them together for Medicare, you have to reduce the amount of your pap, breast and pelvic from the amount you charge your well visit, because Medicare doesn't cover the well visit. (not to be confused with the IPPE or AWV). Check CMS's Preventive guidelines for advice on coverage and diagnosis coding.

Some (most) commercial payers will not pay them separately, and will only cover the preventive visit.
 
check with the patients carrier?

jemimah crescentia said:
Hi:

Rocking New year wishes to all,

Could anyone help me to find out the code for "Annual Gynecology examination" done in Office without any current signs and symptoms,

Did the preventive medicine codes(99381-99397) suits the above scenario?,

I think Medicare uses the code G0101 for well women exam(WWE).

Thanks in Advance,
Jemimah Crescentia, CPC
Click to expand...

The first thing I would do in this scenario is check with this patient's insurance carrier's website or your provider rep for that particular carrier to see if they have any info on it. I say this because I've found that some carriers differ I know some carriers who want you to use the S0610-S0612 codes for this type of visit.
 
Thanks a lot for your guidance,

Could you please let me know the carriers to which the codes S0610 and S0612 should be used or provide any reference material for better understanding,

Regards,
Jemimah Crescentia,CPC:)
 
Make sure to have the patient sign an ABN as Medicare only covers the pap and gyn exam once every two years unless there is a high risk diagnosis. The ACOG website has great information on this and the differences between this exam and the newly covered preventative exam.

Robin King, CPC
 
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