Wiki Pelvic and Breast Exam for High Risk Patients

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jwalker1

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Is anyone having trouble with Medicare denials for the high risk patients for their gyn exams? We use to use the code V15.89 and now we are using Z77.9 but our claims have been denied for invalid code. Any suggestions as to what code should be used for these patients who need to be seen more than every 2 years and are high risk?
 
Annual Exam for Medicare

We bill the annual exam with either
Z01.411 Encounter for gynecological exam with abnormal findings or
Z01.419 Encounter for gynecological exam without abnormal findings.
Hope that helps
 
k adams

We are having the same issue. The codes Z01.419 or Z01.411 are not high risk codes. Any other ideas?
 
We are using Z91.89 for our high risk diagnosis which was listed along with Z77.9 as a possible code for high risk on the summary of Medicare Screening Services provided by ACOG
 
Is Medicare paying when using either the Z01.411 or Z01.419 with a secondary dx code indicating why they're high risk? Thanks!
 
I spoke with Medicare because all codes are being denied for high risk except high risk sexual behavior. They stated there was no link in there system for V15.89 with all the other codes that they had approved for high risk and that is why they are being denied. They are working on this problem but it has been several weeks since I spoke with them and I am still having the same problems.
 
According to ACOG, they put out a Medicare Screening Services 2015 summary. For high risk you would use Z77.9 or Z91.89 and low risk Z12.4, Z12.72, Z12.79, Z12.89, Z01.411, Z01.419. I hope this helps.
 
Ive spoke with Medicare and they said that there is a problem with the hard coding in their claims processing/payment software that left out the high risk ICD10 dignosis codes that are listed in section 30.6 of their manual. They will be updating the software on 1.4.16. MLN article CR9252 will have the details, and there is no word if they will be reprocessing the incorrectly denied claims, or if we will need to submit redeterminations for those claims that they denied due to their error.
 
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