I am confused. I thought in order to bill a preventive physical exam, the patient could not present with other issues. The patient came in for the annual exam and murmur and hypertension as well. The patient has been seen for the murmur and hypertension before and the doctor is just monitoring this on the DOS with the annual exam. I guess my question is can I bill the V70.0, 785.2, 401.9 with a 99395? The insurances we bill will only pay a preventive code is the only dx listed is V70.0. Does anyone else have this problem and how do you get around it?
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Wiki V70.0 and Other Diagnosis?
- Thread starter anne32
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mitchellde
True Blue
since the ICD-10 CM code for the annual prevents you from billing other dx codes with it unless it is an abnormal finding discovered by the provider at the well exam, it is possible that the payers are implementing the edit for this at this time.
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So with ICD-10, if the problem is discovered at the time of the well exam, you would code it onto the claim? How does the insurance know the difference between the patient coming in with this problem and the doctor finding it at the time of service? This is frustrating because I feel that if you can prove it was discovered at the time of service, the insurance will still deny and say it doesn't fall under the 100% coverage.
Petlorilea
Contributor
It does beg the question - can a patient with chronic conditions REALLY have a well visit? The way that I read it...yes they can.
It's a work in progress to get my providers to remember what HPI stands for....if the visit is preventive, there is no history of present illness per se. (I take that to mean their DM or hypertension etc. is controlled, no lump or sprain or dog bite for Heaven's sake!) But I have seen 'patient presents with exacerbation of COPD, requires nebulizer treatment and kenalog injection...and o yah, wants a complete physical'. NOPE!
If there is further workup (I even count if there is an increase/change in current medications) that is documented as being significant enough to warrant separate e/m services, bill accordingly. Keep in mind that not all payers will pay for both on the same day.
It's a work in progress to get my providers to remember what HPI stands for....if the visit is preventive, there is no history of present illness per se. (I take that to mean their DM or hypertension etc. is controlled, no lump or sprain or dog bite for Heaven's sake!) But I have seen 'patient presents with exacerbation of COPD, requires nebulizer treatment and kenalog injection...and o yah, wants a complete physical'. NOPE!
If there is further workup (I even count if there is an increase/change in current medications) that is documented as being significant enough to warrant separate e/m services, bill accordingly. Keep in mind that not all payers will pay for both on the same day.
mitchellde
True Blue
Yes they can but if these chronic issues are all stable then the only reason for the encounter is Preventive.
tvakulchik
New
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question
Can you please tell me what insurance complanies are denying a claim with V70.0 as primary and hypertension (or other medcial conditions) as secondary? I work for an insurance company and as far as I know, we would accept these claims. Not only that, with commerical risk adjustement being new this year, health plans need to get all chonic conditions coded/billed at least once a year and preventive visit is a perfect visit to address any chronic conditions that are stable.
Thanks
Tatyana
Can you please tell me what insurance complanies are denying a claim with V70.0 as primary and hypertension (or other medcial conditions) as secondary? I work for an insurance company and as far as I know, we would accept these claims. Not only that, with commerical risk adjustement being new this year, health plans need to get all chonic conditions coded/billed at least once a year and preventive visit is a perfect visit to address any chronic conditions that are stable.
Thanks
Tatyana
Healthy Connect
Guest
We find these very confusing also. We do bill a diagnosis for an E/M level and
V72.31 for a gyno exam. My question is: A patient presents for an annual, and has a pap done. I get a dx of V72.31. Can I code V70.0 for labs ordered since it states "annual" in the chart?
V72.31 for a gyno exam. My question is: A patient presents for an annual, and has a pap done. I get a dx of V72.31. Can I code V70.0 for labs ordered since it states "annual" in the chart?