Wiki Correct coding for annual exam with Pap and pelvic by a family medicine physician

[kranzfield@gmail.com]

Good morning/afternoon,

I wanted to confirm the correct coding for a woman coming in for an annual exam with a Pap and pelvic. Should it be Z01.419 or Z00.00 with a code for the Pap? Thanks in advance!

 

[csperoni]

If the patient was there for a gynecologic exam, I would code Z01.419. If the patient was there for an overall exam (which happened to include a pelvic), I would code Z00.00.
TYPICALLY a family medicine physician is performing an overall preventive exam and Z00.00 would be more appropriate.
If also billing Q0091, I would recommend Z01.419 if that was on your preventive, or if the preventive is Z00.00, then Z12.4 for Q0091 (assuming not high risk patient). Also assuming there were not abnormal findings on exam.

 

[vnorman]

Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?

 

[csperoni]

This was addressed in your other posting. In the future, please avoid posting the same question multiple times. You often wind up with 2 threads addressing the same issue.

https://www.aapc.com/discuss/threads/pap-smear-without-full-gyn-well-women-exam.192605/?view=date#post-530772