Wiki Problem Visit w/ Pelvic Exam

[LindsayC]

I am second guessing myself and need help. I have a physician who is always circling diagnosis of V72.31 with a "Problem Visit" encounter and a 99213 E/M code.

Example: Pt presents for problem related to nine week one day postpartum visit. There to discuss birth control options. Physician performs exam typical of a well woman exam, but no pap obtained. Patient has commercial insurance.

To me, this is a Well visit. But physician is always documenting as "problem visit" with V72.31. So my question is, can you bill V72.31 as a "pelvic/gyn exam" when they are examining for a problem, rather than a WWE?

Thanks in advance.

 

[teresabug]

your physician cannot bill an est pt E/M i.e. 99213 with V72.31 as the dx. It will deny. If he is seeing the patient for a medical problem outside of what is normally considered as a postpartum care, the visit is included in what he was paid for the global delivery. A well woman exam a.k.a. as a "preventive" is only payable once every 365 days via CPT 993XX whether pt is new or established. Refill of BCP's in not cosidered a medical diagnosis. If he performed a true preventive, his documentation would show a Comp ROS, Comp PFSH and a thorough assessment of risk factors based on the pt's age and gender.