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PREVENTIVE vs. PROBLEM VISIT for GYN

  1. #1
    Question PREVENTIVE vs. PROBLEM VISIT for GYN
    Exam Training Packages
    Looking for guidance on appropriate use of Preventive Medicine coding vs. Problem Oriented Coding for GYN practices.

    Would it be inappropriate to bill a preventive medicine code for a patient who presents for their yearly GYN physical? Or should you be billing a 99201-99215 as appropriate?

    The information documented is as follows:
    age and gender appropriate history,
    examination that includes pap and breast,
    counseling/anticipatory guidance/risk factors,
    and orders as appropriate any associated lab or diagnositic procedures.

    I appreciate any help anyone can give.

    Thanks
    jlf

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    SHIBA425 -
    a yearly GYN "is" preventive service - so I'm not sure why you'd think it could/would be inappropriate to code it as such. In my opinion, it would be inappropriate to code an E/M level for a yearly GYN physical.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. Default
    For private insurance payors you need to use preventative codes based on age, new patient range would be 99384-99387 and established patients would be 99394-99397, using diagnosis of V72.31. If the patient is medicare, you will need to use G0101 for the pelvic and breast exam and Q0091 for the pap smear. Typically you will need a screening diagnosis for medicare coverage and should also review ABN rules on the CMS website.

    Hope this helps some!

  4. #4
    Default Thanks
    To CHEINRICH and DMAEC:

    Thank you for your responses, and opinions. It is very helpful.

    THANK YOU.

  5. #5
    Default
    If there is no problem or complaint then the visit would be a screening visit.

  6. #6
    Location
    Loma Linda
    Posts
    50
    Default Coding GYN visit
    Can anyone tell me where I can find documentation on the guidelines for coding a Well Women visit. Basically where I can get something in writing wherer it tells me to use Preventive visit codes with V72.31 adn Q0091 with V76.2 versus for Medicare Where we use G0101 and Q0091 I have to prove this in a meeting on Friday....

    Thanks in advance

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