Wiki Billing Well woman with problem visit?

[jdibble]

Hi all,

I need to explain to my OB/GYN docs when they can or can't bill a problem visit with a well woman visit and I am very confused on this issue plus everyone in my office seems to have a different opinion on what is separately billable. Does anyone have a source that states what would be considered part of the well woman vs something that is separate?

For example: If a woman comes in for a well woman with a pap (and the doctor does a comprehensive history and exam for this) and also complains of vaginal itching or pelvic pain or breast pain or menorrhagia (dr orders ultra sound, or rx, etc) - is that part of the well woman or can that be considered separate? Or if the doctor finds vaginitis or another dx which now required treatment during his exam - can that be separate? Another one is the patient comes in for well woman and also pessary check (removed, cleaned and replaced) - is the pessary check separate?

I am really just looking for a difinitive way to explain (and understand myself) what would be included with the well visit and what would be separate!

Please help!

Thanks,

 

[tefranklin57]

page 34 of the CPT book explains this, that yes you can code for a preventive visit (well woman) 9939x, and also code for an office visit 9921x-25 for the condition/illness/disease that is being addressed.

 

[jdibble]

page 34 of the CPT book explains this, that yes you can code for a preventive visit (well woman) 9939x, and also code for an office visit 9921x-25 for the condition/illness/disease that is being addressed.

Thanks tefranklin - I re-read the information on this and that does make it a little clearer. I guess what my confusion is that since the patient is here for a well-woman and she has a problem that is in the pelvic area (say vaginitis), which has been examined for the well-woman visit, what element from this exam can be counted towards the problem visit if it has to be separate? Some others in my office feel that if the problem has to do with the pelvic area (such as menorrhagia, pelvic pain) that it should still be part of the yearly. I don't see it that way, but I needed some type of documentation to show them and the doctors what would be the difference between "insignificant or trivial problem" vs a "significant, separately identifible E/M service".

So if someone can explain the difference for me, maybe that would help!

Thanks,

 

[amottice]

Your yearly exam visit would be coded as V72.31 with the appropriate E/M preventative cpt code and your problem visit (IE) vaginitis 616.10 would be coded with the proper problem E/M (IE) 99213 with mod 25 attached to the problem E/M.

 

[bonzaibex]

On order to bill a "separately identifiable" E&M service, you need to make sure the documentation supports a separate E&M code. That is, the elements used for the problem E&M code must be able to stand alone and apart from the WWE elements. No double dipping is allowed. You might want to take a copy of the chart note and highlight everything that counts toward the WWE code. Whatever is leftover has to meet documentation requirements for your chosen level of E&M. A separate chart note could be dictated for the problem, but again, the elements used in that chart note have to be distinct from the elements used in the WWE code.

Becky, CPC