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Well woman and preventive visits

  1. #1
    Savannah, GA
    Question Well woman and preventive visits
    Medical Coding Books
    I am at a family practice where one of my physcians does well woman exams. I had a patient come in on 10/12/10 for her annual physical. When the insurance was contacted on 10/11/10 to verify benefits for her annual physical, they stated it was covered at 100%. The physician had her schedule a well woman exam on 11/29/10. Both visits were coded as 99395. Annual physical dx was V70.0 and well woman was V72.31. Her insurance paid for the well woman but denied the physical stating it was bundled. The insurance is processed following BCBS guidelines. Should I have coded the well woman as a G0101, Q0091 with dx V72.31? or do these commercial insurances only cover one or the other if they are both done in the primary care setting?

  2. #2
    Columbia, MO
    so you billed two line items of 99395? They probably denied the second as a duplicate. I have had a lot of commercials cover only the whole physicial and combine the well woman into it. Some will allow you to bill the G0101 and the Q0091 for the well woman it just depends on the carrier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Is insurance is following Anthem guidelines they will bundled the well woman to the preventive in our office we bill that type of visit this way for example:
    99395 V70.0 V72.31 V76.10
    Q0091 V76.2
    we also bill this way for Tricare, United, and some other carriers Healthkeeper will not cover Q0091

    99395 V70.0
    G0101 V72.31
    Q0091 V76.2

    Hope this may help!
    Mildred Nieves, CPC

  4. #4
    Savannah, GA
    They were billed on 2 separate days because the physicians here will not do both on the same day. I think I might recommend they do so that I can bill the preventive code with the Q0091 on the same day to see if I have any luck. Otherwise, the physicians are going to have to choose whether or not they want to continue this service or send the patient to a gyn.

  5. Smile
    If the dr did the Preventative GYN and it is not Medicare, we bill the 99396 (or whatever)
    and V72.31.
    If the dr does just a preventative NO gyn. We bill the 99396 with V70.0 dx.
    If it is Medicare and all elements of the exam are covered we bill Q0091 ; G0101 ;
    AND 99396 or whichever.
    Does this help ?

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