Wiki Separate GYN after the patient already had annual preventive

[ivygirl18@hotmail.com]

Hello,

I hope someone can help me with this. I have providers who see patients for their GYN exams after they have already been seen for their preventive visit. They are either billing a 99212 or 99213 with the Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings. I do not know if this appropriate.

There are only a few insurances that a preventive visit and GYN exam with either S0612 or G0101 can be billed during the same year. So what do you bill for when the patient has already had their preventive visit for the year and their insurance does not recognize the GYN codes???

 

[atilton]

We just went through this in our family practice. In all actuality when you read the CPT manual it can be argued that the annual pap/pelvic is inclusive to the annual physical. It states "an age appropriate history/exam". So patients should really get their pap/pelvic at their physical. So we have had our registration staff remind female patients to be prepared for their pap/pelvic. We do still have those patients who don't have it done at their physical for whatever reason and return. If the patient has any medical indications in addition to their pap/pelvic we bill a sick visit 99211-99215 with the medical indication dx as primary. If they simply have come back for routine pap/pelvic we bill the Q0091 and the G0101 (if breast and pelvic done). We have confirmed with our major payers Blue Cross, Medicaid, etc that it isn't unethical to bill Q0091 and G0101 for non-medicare pts. We so far have only seen denials when we are billing a Q0091 and an EM and from one payer that doesn't accept the Q0091. Unfortunately the insurances haven't given us a better option for these routine paps outside of the routine physical so you kind of have to work with your providers and management to come to the best option for your practice that's both ethical and reasonable.