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Wiki Well Woman exam and Annual Preventive on same claim

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sedel1156

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Palm Harbor, FL
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Hello all. I would love to hear feedback on this. I have a provider (Family medicine) who consistently reports Z00.00 and Z01.419 on her encounters. I have tried to explain that these diagnosis codes are not allowed on the same claim. The response I received was, "As a family physician I include the well woman exam (pap/pelvic and breast exam) in the annual wellness visit.". I have been trying to find documentation that specifically states that the two dx codes cannot be billed on the same day, same claim. Trying to keep this on a very professional level, as I am just starting to code/bill for this provider and want to establish a good rapport. Any help will be very much appreciated!
Thank you!
 
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Hello. Only one should be reported and since the provider is Family Medicine, they would report Z00.00 for annual preventive and Z12.4 for pap smear. The pelvic and breast exam is included in Z00.00.
 
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Also, category Z01 has a type1 excludes for Z00.0-. So if the provider wants an "absolute" rule, show them the definition for Type 1 excludes.
 
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