Wiki Z00.00, Z00.01, Z00.419 when billed with sick OV

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jorellana42

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Hi, everyone!

I'm seeing a lot of claims where my providers are seeing patients for a CPE or a Well Woman Annual exam, and they're using 99201-99215 along with Z00.00, Z00.01 and Z00.419 as the primary dx. The payers are paying the claims as they are coded, for the most part. I'm wondering if this is allowable, and my only gripe is the money we're losing out on by not coding 99385-99397? Is there documentation I can show my providers that says that this is not allowed?

Thanks!
 
Hi,
even i came across such scenarios where insurance is paying for CPT 99201-99215 with Z00.00, Z00.01 & Z00.419 .
There is certain requirements in documenting MR to support for CPT 99385-99397 which seems to be little difficult and most records does not meet such criteria, so instead to get them paid insurance ask to bill with cpt 99201-99215.

hope this helps.
 
Thanks for that information. My problem is that for most of the time, the EHR does indicate CPE or Well Woman exam. Shouldn't this be enough to code the 99385-99397?
 
My understanding is that you should be able to bill a physical CPT code with your Z code and then bill a low level office visit with modifier 25 for the acute problem (the exam portion for the illness).
 
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