Wiki Two diff. DOS for routine PE and gyn

Katy, TX
Best answers

I have reviewed previous posts. Though, based on the answers and coding world, I would agree but I am looking at my issue from an INSURANCE POV.

We are starting to have patients wanting to do their breast/pap exams on a different DOS from their routine PE. I'm sure I'm not the only one seeing denials on regular E/M codes for using a V70.0 or V72.31 diagnosis.

We would bill a preventive code for the routine PE V70.0 on one DOS. Patient comes in a few weeks later to do their breast/pap and we have to use an E/M code because based on most insurances, they only pay for ONE routine physical a year. We are receiving denials when we use an E/M with V72.31. There is no PAP code for regular insurance. the G0101 and Q0091 are Medicare codes which we would bill for our breast/pap, but with regular commercial, you can't. Though, the routine meets criteria for a preventive and so does the breat/pap exam. We can not bill a preventive code twice in a 12 month period. When there are NO other issues being addressed, we're left with the routine codes for diagnosis.

Does ANYONE have an advice on this? We try to encourage doing both on same DOS, but it's left up to the patient of course.

Any help would be appreciated!!!! Thanks!