Wiki PCP and GYN Annuals

[samantha Martel]

We are an OBGYN clinic and we have a Nurse Practitioner who can perform both the PCP and GYN portions of the annual physical. I am wondering exactly how we should code for this. Would I use both diagnosis codes V72.31 and V70.0 with mod 22 for prolonged services?

Thanks for help!

diagnosis codes, diagnosis coding

 

[mitchellde]

you cannot add the 22 modifier to an E&M service. most payers accept the G and the Q code for the well woman exam, so when both are performed we have always billed using the preventive code linked to the V70.0 and the G and the Q code linked to the V72.31.. The V70.0 must be first listed

diagnosis codes, diagnosis coding

 

[samantha Martel]

I thought those codes only applied to Medicare, can they be used for all payers

diagnosis codes, diagnosis coding

 

[mitchellde]

yes they are designated as "payer discretion" codes.

diagnosis codes, diagnosis coding

 

[Anastasia]

G and Q codes are solely Medicare codes. If you bill the 993-- codes to Medicare, they are non-covered and the patient will be responsible. Make sure the patient is aware of this before the exam and have her sign an ABN.

diagnosis codes, diagnosis coding

 

[mitchellde]

The G and Q are not solely Medicare they are accepted by many commercial payers.

diagnosis codes, diagnosis coding

 

[Anastasia]

In my area they are Medicare-related codes.

diagnosis codes, diagnosis coding

 

[mitchellde]

Yes they are Medicare related in every area, What I am telling you is they are designated as carrier discretion codes meaning any carrier can chose to accept them and most do even in your area. you need to check with them, it is the only way to obtain separate reimbursement for an annual and well woman on the same day.

diagnosis codes, diagnosis coding