Wiki I need a 2nd opinion on this case

[dan528i]

Hello Coders,

Please check this and tell me if I am correct or I am loosing my mind

Ptn Present in OB/Gyn office w/ c/o "I'm bleeding" Ptn has IUD copper T/ aslo Vag Discharge w/ odor.

Doctor does full check up, IUD Surv (Transvag sono, Pap/Hpv/GC/CT and Breast/Pelvic Exam
RX for metro-Gel/Clindesse/ DDiflucan/ Ibuprofin

I bill 99215-25 with 626.2, 616.10, v25.42
76830 with 626.2, 616.10, v25.42
Q0091 with v76.2 (last Pap done in 2008)(10 months ago)
G0101 with v76.19

INS.: Pays for 76830 and G0101
Denies 99215-25 as incidental to G0101 AND
Denies Q0091 as Not a payable code.

Now this ins company never pays for Q0091 which we w/off BUT
Denial on 99215 as incidenal to Breast exam when primary DX are Menorrhagia, BV and IUD check up is a bit much I though.

Can you please look this over and let me know what you guys think?

THANKS ALOT!!!

 

[Anna Weaver]

2nd opinion

Hello Coders,

Please check this and tell me if I am correct or I am loosing my mind

Ptn Present in OB/Gyn office w/ c/o "I'm bleeding" Ptn has IUD copper T/ aslo Vag Discharge w/ odor.

Doctor does full check up, IUD Surv (Transvag sono, Pap/Hpv/GC/CT and Breast/Pelvic Exam
RX for metro-Gel/Clindesse/ DDiflucan/ Ibuprofin

I bill 99215-25 with 626.2, 616.10, v25.42
76830 with 626.2, 616.10, v25.42
Q0091 with v76.2 (last Pap done in 2008)(10 months ago)
G0101 with v76.19

INS.: Pays for 76830 and G0101
Denies 99215-25 as incidental to G0101 AND
Denies Q0091 as Not a payable code.

Now this ins company never pays for Q0091 which we w/off BUT
Denial on 99215 as incidenal to Breast exam when primary DX are Menorrhagia, BV and IUD check up is a bit much I though.

Can you please look this over and let me know what you guys think?

THANKS ALOT!!!

Is the patient a medicare patient? I only use the G and Q codes for medicare and consider the pap inclusive to the E/M for all others. So, if this were me, I would have billed the 99215-25 and the 76830.

Anyone else?

 

[dan528i]

Its NOT a medicare ptn but most of ins comp in NY pay for G and Q codes (I think it depends on provider contract). In this case it was actually Oxford which by the way never paid neither Q nor G but this time they paid G0101 and denied E&M.

 

[LLovett]

I'm having a hard time with the 99215 plus screening codes.

It sounds to me like this ended up being more of a yearly exam, since you used the words "check up" than the highest level problem visit.

If you can truly support a 99215, I would think breast exam would be included in that, same thing with a pap collection.

Just my opinion,

Laura, CPC

 

[Anna Weaver]

2nd opinion

I have to agree with you, I posted and then questioned the 99215 myself. We have providers here who believe they should code the 99215 instead of the preventive visits. We're having a hard time getting them to conform, but we're working on it.

 

[dan528i]

I'm having a hard time with the 99215 plus screening codes.

It sounds to me like this ended up being more of a yearly exam, since you used the words "check up" than the highest level problem visit.

If you can truly support a 99215, I would think breast exam would be included in that, same thing with a pap collection.

Just my opinion,

Laura, CPC

OK but why would the breast exam and PAP be included? Ptn present w/ c/o vaginal bleeding.

 

[LLovett]

How are you supporting the 99215?

I don't see how you would get high complexity mdm ( I could be wrong though), so I am assuming you are supporting it with comprehensive history and exam, which should include the exam elements for breast and vagina in this patient.

Just my take,

Laura, CPC