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billing for 99211 and Pap on same day

  1. #1
    Default billing for 99211 and Pap on same day
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    I need some help on this subject.
    Patient presented for PAP and the provider also did a breast exam.
    Our biller and provider want to bill for 99212 on the grounds that the patient has not had a breast exam in 4 years. I feel we should only be billing for the PAP and breast exam.
    She is not complaining of any lumps, drainage or pain. she is requesting referral for mammogram.

    I have included the note below for review. Thank you for any advice you may have to give.


    Chief Complaint
    The Chief Complaint is: Pap Smear & mammo script.

    History of Present Illness

    • Medication list reviewed.
    No breast lump No nipple discharge No pain in breast

    63-year-old female that presents today for her annual Pap smear. She reports that they have been several years since her last Pap. She reports that she went into menopause in her 50s. After some discussion and chart review we have figured out that it was around 10/31/2008. She reports that she has been feeling well. She reports that she at one time did have an abnormal Pap. She is also requesting a prescription for a mammogram.
    She denies any incontinence.

    Review Of Systems
    Systemic: Not feeling tired (fatigue). No fever and no chills.
    Breasts: No breast lump, no nipple discharge, no inversion of the nipple, and no pain in breast.
    Cardiovascular: No chest pain or discomfort.
    Pulmonary: No dyspnea and no cough.
    Gastrointestinal: Normal appetite and no abdominal pain.
    Genitourinary: No increase in urinary frequency. No urinary urgency. No urinary loss of control and no dysuria. No genital lesion. Menopause occurred at age 53. No menopausal concerns. No vaginal discharge.
    Endocrine: No polydipsia and no excessive sweating.





    General Appearance:
    Normal. Well developed. Well nourished. In no acute distress.
    Lymph Nodes:
    Supraclavicular lymph nodes were not enlarged.
    Breasts:
    General/bilateral:
    • Soft breasts. Appearance of the breast was normal. Palpation of the breast revealed no abnormalities. No breast mass was found. No tenderness of the breast.
    Lungs:
    Normal breath sounds/voice sounds. No wheezing was heard. No rhonchi were heard.
    Cardiovascular:
    Heart Rate And Rhythm: Normal.
    Heart Sounds: S1 normal.
    Abdomen:
    Auscultation: Bowel sounds were normal.
    Palpation: Abdominal non-tender.
    Pelvic:
    Vagina: Normal.
    Cervix: • Pap smear sample taken. Normal. No cervical discharge.
    Uterus: Position was normal. Not tender.
    Uterine Adnexae: Uterine adnexa was not tender on the right. Uterine adnexa was not tender on the left.
    Neurological:
    Oriented to time, place, and person.
    Skin:
    General appearance was normal.

    Assessment
    • Visit for: gynecological exam with pap smear

    Plan
    gynecological exam with Pap smear. Patient tolerated procedure well without complaints. I have given her prescription for mammogram. As she has not had one since 2014. We have discussed supportive measures.

    Follow-up as priorly scheduled or sooner if needed.
    Last edited by Peanut1964; 11-07-2018 at 10:13 AM.

  2. #2
    Default
    Based on the documentation provided the breast exam does not warrant a 99211. The patient presented for and received a pap smear. The breast exam on it's own does not support an additional E&M. It was not mentioned in the history nor in the assessment of the patient. It would not meet the requirement of 2 of 3 for established patient or 3 of 3 for a new patient.
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

  3. #3
    Default
    Quote Originally Posted by Chelle-Lynn View Post
    Based on the documentation provided the breast exam does not warrant a 99211. The patient presented for and received a pap smear. The breast exam on it's own does not support an additional E&M. It was not mentioned in the history nor in the assessment of the patient. It would not meet the requirement of 2 of 3 for established patient or 3 of 3 for a new patient.

    Thank you very much for your input, as I too thought it did not meet the requirement. It was actually being billed as a 99212, I was incorrect in my post. Even then it would still not meet requirements, correct?

  4. #4
    Default
    Medical Billing
    Correct.
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

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