Wiki Preventive VS Well Woman Exam

[em2177]

Pt was seen on 10/27/14 for a Physical Exam provider documented 99396. Pt was back in the office on 11/10/2014 for a Well Woman Exam provider documented 99396 again.
Based on the documentation the visit on 10/27 was a completed physical exam. The visit on 11/10 was for a pap smear and UTI. The second visit would be coded as a f/u 99212-99214 correct?
My understanding is that 99395-99397 codes can only be billed once a year.....
Any suggestions?

 

[elysia.york]

I work at Primary Care office and run into this issue a lot. All insurances, that I am aware of, will only pay for one 99395-99397 in a calendar year or 365 day period, which that part depends on the insurance carrier. All you can really do is ask the patient a head of time whether or not they have already had their "annual exam" and explain to them the issue. At our office we do not ask this, but if the patient calls with a bill after it is filed and it is from a denial of their preventive exam, we explain to the patient why it happened and that we will be more than happy to refile it for them with a different OV code. So then, 9 times out of 10, this will be covered and the patient will not be left with any balance...unless of course any of it is applied to their deductible.

 

[Lukelie]

the preventive medicine codes may be used twice a year if allowed by the carrier. One for PCP preventive with V70.0 and one for a well woman with V72.31 by the Gyn provider. They are two different preventive exams. However, if the same provider is doing the service why wouldn't the pap be done at the time of the annual exam? To have the patient return for a pap doesn't seem correct but I believe it is allowable. I have a family medicine provider who does this but we don't know why the patients would come back twice.. hope this helps.