Wiki Medicare Well Visit

[julieclifton2011]

Learning something new everyday

Medicare patient seen on 10/18/10, charge billed as 99397 and the claim was denied. She was seen the year before on 10/05/09 for her WW visit. Can you please help me with the correct CPT for the 2010 WW visit that Medicare denied. The ICD-9 that was used was V72.31.

Thanks so much for all the support

 

[LindaEV]

Medicare does not cover the 99397, as you now know.

Usually a Medicare woman will get an exam that is billed with a G0101.
Also if a pap as collected you can bill a Q0091.

These two codes are limited to the actual "womanly parts"...so anything above that will have to billed separately...maybe to the patient in the form of a reduced 99397.

Here is a good link:
http://www.acog.org/departments/coding/MedicareScreeningServices.pdf

I'm curious how you billed the year before? Is she straight Medicare and not a medicare replacement plan right? (some of them cover the 99397)

Your dx is correct. email me if you'd like...I have a cheat sheet I can send you. lvargas@cassregional.org