Wiki GYN visit with office visit

[Swooshjoe3]

hello, new to the forum and need some help:

we have a provider billing a wellness exam 99385/99386 with icd V72.31 (routine gynecological exam). provider is also billing a a new patient office visit and has done so with the following ICD codes:

611.72 Lump or mass in breast

616.10 Vaginitis and vulvovaginitis, unspecified
625.90 Unspecified symptom associated with female genital organs
626.00 Absence of menstruation
626.20 Excessive or frequent menstruation
626.60 Metrorrhagia
626.70 Postcoital bleeding
626.80 Other (Dysfuntional or functional uterine hemorrage NOS, Menstruation: retained, supression of)
627.20 Symptomatic menopausal or female climacteric states


is the office visit reimbursable with any of these diagnoses?

 

[mitchellde]

I truely feel this may be way over coded. I would need to see the entire note.
But honestly how can a patient complain of an absence of menstruation( must be an absence of 6 months or greater), and excessive mentruation, and frequent etc. all at the same encounter?

 

[Swooshjoe3]

i apologize for the confusion....this is a bundle of claims submitted, all with 99385/99386 and icd V72.31 billed together then the separate e/m with one of the below diagnoses

 

[mitchellde]

ICD-9 allows this as long as the patient utter the symptom or complain upon entry into the office. If the patient did not have a symptomatic concern documented then you may not charge an office encounter in addition. FYI, ICD-10 CM codes do not allow using the prevent codes with symptom codes. Therefore come Oct 1 this can no longer be coded this way. It is either a visit for wellness or it is a visit fir symptoms.
When you do bill the preventive E&M with the office level, you need to be able to clearly distinguish both levels in the documentation without duplication. The AMA has previously stated that the level of service then should not exceed the level 2. So be careful of using higher visit level with the preventive level.

 

[aharapat913]

Also, if it is a new patient you should code the annual as new patient and the office visit as established with a modifier -25 to the office visit.