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Medicare Well Visit

  1. Default Medicare Well Visit
    Medical Coding Books
    Learning something new everyday

    Medicare patient seen on 10/18/10, charge billed as 99397 and the claim was denied. She was seen the year before on 10/05/09 for her WW visit. Can you please help me with the correct CPT for the 2010 WW visit that Medicare denied. The ICD-9 that was used was V72.31.

    Thanks so much for all the support

  2. #2
    Kansas City, MO
    Medicare does not cover the 99397, as you now know.

    Usually a Medicare woman will get an exam that is billed with a G0101.
    Also if a pap as collected you can bill a Q0091.

    These two codes are limited to the actual "womanly parts" anything above that will have to billed separately...maybe to the patient in the form of a reduced 99397.

    Here is a good link:

    I'm curious how you billed the year before? Is she straight Medicare and not a medicare replacement plan right? (some of them cover the 99397)

    Your dx is correct. email me if you'd like...I have a cheat sheet I can send you.

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