Our office is billing V70.0 and 99395 for an annual physical exam. Then the patient comes back for another visit where a well woman gynecological exam and pap is done with diagnosis V72.31. My question is, can we bill the second visit? or is it all included in the initial 99395 already paid?
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Wiki Preventive coding
- Thread starter Boop0098
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tdml97@yahoo.com
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As far as I understand, if they come back another day for GYN it should get paid. If it is done on same day as Well visit - then its included.
mlbaker1974
Networker
My question as an auditor would be, why did the provider wait a week to do the GYN exam instead of with the routine physical? Yes you can bill for the second exam but I would limit it to the pap/GYN exam and would not bill another 99395, that is a pattern that can easily be picked up if it is happening with multiple patients and can be a red flag to insurance carriers.
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mlbaker1974
Networker
preventative coding
I am not aware that there is any law saying you can not assign a new patient E/M, my recommendation is pick the E/M that best represents the encounter. To me a preventative is going to be a comprehensive evaluation of the patient's history and physical condition and include counseling on issues or behaviors that may cause health issues in the future and include a plan to reduce the patient's risk for potiential health issues.
Hope this helps.
I am not aware that there is any law saying you can not assign a new patient E/M, my recommendation is pick the E/M that best represents the encounter. To me a preventative is going to be a comprehensive evaluation of the patient's history and physical condition and include counseling on issues or behaviors that may cause health issues in the future and include a plan to reduce the patient's risk for potiential health issues.
Hope this helps.
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MnTwins29
True Blue
Since an office visit E/M requires a chief complaint, not sure if that would work. This is the definition of the CC from the CMS Documentation Guidelines:
"The CC is a concise statement describing the symptom, problem,
condition, diagnosis, physician recommended return, or other factor that is
the reason for the encounter, usually stated in the patient's own words.
• DG: The medical record should clearly reflect the chief complaint."
The only way I could even see this possible with the return for the GYN exam only is a "physician recommended return" - but that could be a stretch as well. Not saying that the 99202 CANNOT be used - but make sure the documentation supports it (duh!)
"The CC is a concise statement describing the symptom, problem,
condition, diagnosis, physician recommended return, or other factor that is
the reason for the encounter, usually stated in the patient's own words.
• DG: The medical record should clearly reflect the chief complaint."
The only way I could even see this possible with the return for the GYN exam only is a "physician recommended return" - but that could be a stretch as well. Not saying that the 99202 CANNOT be used - but make sure the documentation supports it (duh!)