Most commercial plans will allow separate annual exams for a general annual wellness check-up and an annual well woman (gyn) exam when provided by 2 different providers with different specialties billed with the 993xx comprehensive preventive E&M codes. I think it is critical to use the Z00.00 or Z00.01 for annual wellness check-up with the PCP and Z01.419 or Z01.411 for the annual well woman exam with the gyn.
If a carrier does not allow more than 1 993xx comprehensive preventive E&M code to be billed per year you can use the 993xx E&M code for the general annual wellness check-up exam and then you could use the following HCPCS codes for annual well woman exams.
- S0610 - Annual gynecological examination, new patient
- S0612 - Annual gynecological examination, established patient
- S0613 - Annual gynecological examination; clinical breast examination without pelvic evaluation
- G0101 - Cervical or vaginal cancer screening; pelvic and clinical breast examination
There are also prolonged services preventive services codes that could be used with either of these annual exams.
- G0513 - Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
- G0514 - Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)
As always, I would recommend checking on the policies of each of the major insurance carriers to find out what their policies are regarding these benefits. As well as any resources that might have on how to bill these services, so you are successful in being reimbursed for these services.