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Preventive Medicine Codes versus E/M Codes

  1. #1
    Harrisburg, PA
    Cool Preventive Medicine Codes versus E/M Codes
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    Can anyone tell me if there is something in writing regarding physicals for medicare. Since medicare will only pay for gyn exams every 2 years is it acceptable to bill a regular E/M code the other year or should it be billed with a Preventive Medicare Code (99381-99397).

  2. #2
    Columbia, MO
    It should be billed with a preventive medicine code as that is the type of encounter it is.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Medicare doesn't pay for the exam (99381-99397) at all. What you can do is carve out the parts they do pay for so the patient pays less for the exam.

    Instead of your normal fee of say $190.00 for 99397, you would break it down.

    99397 $100.00
    G0101 $ 50.00
    Q0091 $ 40.00

    So Medicare would pay for the 2 components if eligible, and the patient would be responsible for the E/M.

    It is not acceptable to code a problem visit when it is a preventive just to get it paid.

    Laura, CPC

  4. #4
    Harrisburg, PA
    Patient is also being seen for chronic conditions at the same time as the physical, such as hypertension, diabetes, etc. Should I still be just billing the preventive codes?

  5. #5
    Columbia, MO
    I agree with Laura, the chronic problems are just part of what the patient is all about. Tp review a pts chronic conditions is an integral part of the preventive visit so it is not a problem encounter.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    If you do have a significant amount of extra work in addition to your preventive service you can and should bill the problem visit in addition to the preventive. This however is not a carve out service, it would be an additional expense to the patient.

    Laura, CPC, CEMC

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