Wiki How to bill a non-physical visit and pap smear?

[nicoleysmith]

Private payer:

Patient presents to family practice on 03/12/2020 to establish care and refill contraceptive prescription. Provider does history (going over side effects of medication), ROS, exam: bills an e/m. Note indicates patient will schedule a physical and pap smear for a future date.

Patient presents again 03/17/2020 for pap smear: scheduling and chief complaint both indicate it is only the pap smear. Provider again reviews history (going over side effects of medication), ROS, exam, and performs the pap smear. Provider wants to bill an e/m because they did not perform a full physical.

We are unsure how to bill for this because what the provider covered in the second visit was covered in the first except for the pap smear. At the second visit, can we bill a low level e/m because the provider did the work?

Any input is greatly appreciated. Thank you!

 

[csperoni]

1) Overarching criteria for coding is medical necessity. What was the medical necessity of 5 days later reviewing history, ROS and exam when the first visit already determined that PAP smear would be done?? I think unless there was a reason for the 2nd visit, this is not billable.

 

[nicoleysmith]

Anyone?

 

[nicoleysmith]

Thank you so much. I really appreciate it!