Question-OB/GYN Preventive checkup for patient under 18

mckaya

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North Richland Hills, TX
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How do you bill Medicaid for a 16 year annual checkup one year after delivery of baby.
Do you use preventive cod8ing Z01.419 and CPT code 99384 or an different ICD-10 code and E/M.
Any help or guidance will be greatly appreciated.

Thanks
 

nielynco

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Guadalupita, NM
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How do you bill Medicaid for a 16 year annual checkup one year after delivery of baby.
Do you use preventive cod8ing Z01.419 and CPT code 99384 or an different ICD-10 code and E/M.
Any help or guidance will be greatly appreciated.

Thanks
Which Medicaid program? All of these programs have a policy manual which will tell you whether you use the preventive medicine codes, or a problem visit code with or without a modifier sometimes. If you were billing commercial you would bill the 99384 linked to Z01.419, but many state's Medicaid programs have their own set of coding guidelines. Usually you can access the policy/billing manuals online, but if you have a large Medicaid patient load you should have the manuals on your bookshelf on as a computer file for easy reference.
 

mckaya

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North Richland Hills, TX
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Which Medicaid program? All of these programs have a policy manual which will tell you whether you use the preventive medicine codes, or a problem visit code with or without a modifier sometimes. If you were billing commercial you would bill the 99384 linked to Z01.419, but many state's Medicaid programs have their own set of coding guidelines. Usually you can access the policy/billing manuals online, but if you have a large Medicaid patient load you should have the manuals on your bookshelf on as a computer file for easy reference.
Thank you for the feedback. Procedure code 99384 and 99385 are not a payable under Texas Medicaid fee schedule for wellness visit by an OB/GYN which prompt my question to see if there were other plans or Medicaid programs that reimburse for patient 16 years old and younger.
 

sls314

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Toledo, OH
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Thank you for the feedback. Procedure code 99384 and 99385 are not a payable under Texas Medicaid fee schedule for wellness visit by an OB/GYN which prompt my question to see if there were other plans or Medicaid programs that reimburse for patient 16 years old and younger.


According to the Texas Medicaid provider manual online, it looks like they would take the codes 99202-99205 and 99211-99215.

Disclaimer - I do not code or bill for Texas Medicaid, so I'm definitely not an expert on their billing/coding.

My answer is based on what I skimmed in the Texas Medicaid Provider Manual Online, specifically from the chapter titled "Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook" that is available in PDF format. You can review the handbook on the Texas Medicaid site at the link below:

 
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