Wiki Annual GYN Exam no pap

[espforu]

If a patient comes in for annual gyn exam not including a pap(just a breast and pelvic exam). Should the preventative medicine code be used? If not what cpt code do we bill? I am thinking the preventative as it is just preventative. The provider is saying no and is concerned that the patients insurance would deny when the patient goes to their primary care provider for a general preventative medicine visit.

My thoughts are when the preventative medicine code is submitted with the diagnosis of encounter for gyn exam(Z01.411 or Z01.419) it will clarify that the exam was only GYN not a routine.

Thoughts? If you have any references I can provide it would be wonderful

Thanks!

 

[lorilynn7657]

You are correct. You should bill the preventive visit, whether or not the pap was done. The diagnosis will differentiate between this gyn visit and her routine physical by her PCP. It will depend on the patient's plan if they reimburse for both in the same year (many do, although I've had to call and argue with the carrier on some). I don't know of any documentation other than the definitions in cpt. My argument would be, if doc wants to bill a problem-oriented E&M service, z01.419 would be a cpt/dx mismatch and would likely deny.