Wiki Documenting High Risk Medicare Patients

[abctibbett@gmail.com]

Our clinic has quite a few Medicare patients that are seen for their annual well woman exam. Medicare only covers this annually if the patient is high risk.

My question is documentation regarding the high risk aspect. If the patient refuses to answer the sexual health questions, we cannot bill with code V15.89. Correct? I'm erring on the side of caution and advising our providers that if they do the exam every year, we won't be reimbursed for it.

Suggestions?

 

[LBC_CPC719]

High risk medicare

Medicare has their guidelines on what they consider High risk. This is the correct code, however make sure it meets medicare guidelines.

 

[abctibbett@gmail.com]

Documentation

I'm not questioning the code, V15.89. I'm concerned with the documentation in the notes. If we cannot document that the patient has had five or more sexual partners or the other history questions, due to the patient's refusal to answer the questions, that means we cannot use V15.89. Correct?