Question Coding Pap Visit After Physical Billed

jhanmer83

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How do you bill for a visit with the OB/Gyn provider when the patient presents for their pelvic/pap if they've already had a physical with their PCP (commercial insurance)? If I bill an office visit with Z12.4 it denies for screening in conjunction with routine exam. If I bill another physical with Z01.419 it also denies. I'm curious to see how other entities bill these because I have one very frustrated provider.
 

csperoni

True Blue
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There is no reason you shouldn't be paid for a well-woman exam 99381-99397 with Z01.411 or Z01.419.
There are some carriers that may initially deny, but a standard form appeal letter stating this was a preventive well-woman exam by an ob/gyn separate from any preventive exam by a PCP (internal med, fam practice, etc) should be all it takes. Sometimes even just a phone call or a website request gets the job done without an official appeal letter.
I have limited personal experience with preventive side of ob/gyn, but from my colleagues, I hear there are a handful of smaller carriers who like to initially deny but most of the major carriers won't have an issue.
 
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