Wiki Two wellness exams?

[Radcoder86]

If a patient sees a gynecologist for the female part of wellness, then sees their PCP for a wellness without the female exam, what CPT codes are used? Are both providers allowed to bill a wellness CPT?

 

[em2177]

Preventive Medicine
99381 - 99387 New Patient
99391 - 99397 Established Patient

Well woman exams may be billed if the patient did not have a pap smear and breast examination performed during the preventive exam. Components must be clearly documented.

Codes for Well Woman Exam:
CPT: 99384 - 99387 or 99394 - 99397
ICD 9 Pap Smear: V76.2, V72.31, V72.32, V76.47
ICD 9 Mammogram: V76.10, V76.11, V76.12, V76.19

 

[Dorthi]

Wellness exam

It depends on how the GYN coded the exam, you can call to see when they had their last wellness exam by calling the insurance company. I have had times where they used the physical exam code and then we didn't get paid for it.

 

[teresabug]

I was told by BCBS of MI the following:

Preventive with no pap: bill 993XX with V70.X icd 9

Preventive with pap: bill 993XX with V76.31 or appropriate icd 9 based on pt's gyn hx.

We are getting paid here in MI.

Teresa

 

[mderemer]

I don't know of any insur that will pay a wellness CPT more than once in a one year time frame. Would the GYN be performing all wellness criteria/bullet points required such as routine blood work, counselling on diet, etc that the PCP would do (?).