Wiki Breast Exams in Office

[s7mich@hotmail.com]

I am billing Z12.39 to an Insurance company and they are stating that the diagnosis can not be billed with the place of service (11). The patient is coming in for her annual breast exam after getting her Mammo done so I am a little confused on this issue. Would that not be the proper code to use when billing an E/M code for a breast check. Please help..

 

[thomas7331]

Which E/M code are you billing? Most E/M are problem visit codes which wouldn't be appropriate for a screening/preventive visit.

 

[s7mich@hotmail.com]

Billing the standard E/M code. The insurance company is a Medicare Advantage plan.

 

[thomas7331]

I'm not sure what the 'standard' E/M code is, but outpatient E/M codes 99201-99215 would not be compatible with a screening because you need a chief complaint and a problem that is being managed - screening is a preventive service and by definition without symptoms. Maybe consider G0101, or S0613 if the payer accepts it?