Ob-Gyn Coding Alert

Florida Subscriber
 
 Answer: In virtually all cases, you cannot bill for both preventive and problem-oriented care during a well-woman visit. The rule stems from the CPT book -- the note under the preventive codes -- that was added due to Medicare rules for carving out. Whether you treat the complaint or not has nothing to do with it. You can carve out a problem visit only if a significant problem was documented. This means additional history and medical decision-making, something most physicians fail to document separately from the preventive care. Also, most payers see the two codes on the same date as double billing for essentially the same service. So the best rule is to decide which service predominated the visit that day -- preventive or problem -- and bill that only.