Wiki Wellness exam - No idea where to start

[AprilSueMadison]

I've been here for years and this is the first Derm wellness exam I've ever encountered. I have before me a wellness exam form from her insurance company stating she is eligible for this.

Pt is 64 and has commercial insurance.

She came in for a skin screening and in the process has a destruction of an ISK (17110).

I don't even KNOW where to start. I've called Aetna who was no help unfortunately.

Do I bill an office visit? Is there a wellness exam code (DX or CPT)? What do I charge for? As in...what procedure codes go out with a fee? I found G0439, but I'm not for sure that applies...and even if it does, do I add to the claim in addition to the OV code and procedure code?

Also...I'm looking at my CPT book (at codes 99381-99396)...and it seems her screening would fall under 99396, and based on the extensive OV, she would also be charged an E/M code and the procedure code 17110. I'm I misinterpreting this? I'm very confused.

Thank you!

 

[cjhalk@yahoo.com]

I think I would start looking at her past history and CC on this one. She is an established patient - per your 99396 -

My overall gut says no, I wouldn't code a 993XX at all.

I would say, first and foremost, what was the purpose of the visit? If the purpose of the visit was routine in nature AND lesions, I would then question why is the patient and the insurance saying a specialist is granted the ability to use a routine code. I can't get out of my head that the patient must have either a strong family history of or the patient has a history of skin cancer, skin....something that would warrant a preventative visit. If the patient has concerns about her skin either history of or family history of, to me, that’s a clear chief complaint and wouldn't be preventative in nature.

Has she ever addressed her lesions before? Was there ever a plan to remove them? If so, then I would say again that this is not preventative.

If this truly is the first time the patient has addressed this lesion, I guess you could call it routine if the patient says I just want my skin checked out.

I wouldn't use the G code - that’s for Medicare only.

Your right those, this is a bit confusing. I'm not sure I am correct, this is just my thoughts.

 

[rryder1963]

It would be a new patient OV and the procedure code.

Billing preventive service E/M codes would not be appropriate for this type of encounter. Those are typically only for annual physicals.

 

[ajgibson]

Hello,
You really should keep trying to get ahold of the insurance company! We have patients who come in with insurance forms to be filled out for BCN. They want a 99080 (FORM FEE) and say they will pay $40 for it. They also list guidelines for billing it, including that they will pay for this service along with other E/M visits.
Hope this heps, and good luck.