Wiki Annual Exam

[hwtravis@yahoo.com]

I work for an outpatient OB/GYN Center. Most of our patients are Medicaid patients. If a patient had a preventive visit last year but pap was not due, can I code a preventative visit this year if the PAP was done? My providers are telling me Medicaid will only allow a preventive visit every 2 years? The provider coded this year's visit as an established(99213)visit.

 

[hollyw42]

Double check with the payer(s) to see what they cover and how often they cover it. I have never heard of a medicaid policy only covering a preventive service every two years, but medicaid policies vary by state - they are covered every year in Maryland. The only payer I know of with a 2 year (or 24 month) policy on certain 'preventive' services is Medicare.

Payment policies aside, if the provider is performing a preventive visit that is what should be billed regardless of whether or not it will covered/paid. You have to bill for what was performed/documented. If you get a request for medical records and your documentation does not support your billing the claim will be denied anyways.

 

[muschy]

I have a preventive question

I work for a new PCP office, and most of the patient are new. Therefore, I would like to know if I can code a new office visit with a preventive visit? Should I use mod 25? Please advice.

 

[tracylc10]

https://www.cms.gov/Medicare/Preven...ervices/MPS-QuickReferenceChart-1.html#PELVIC