Wiki GYN Well Woman and Problem Visit

[Lb6731@hotmail.com]

Hello and thank you in advance. I am struggling with billing an office visit with a well woman. Here are abbreviated notes: Est female patient 32 years old 1) Annual Exam 2) Preconception Counseling: Discussed PNV ,offered carrier screening, 3) Vaginismus : Continue working with pelvic floor PT and vaginal estrogen and 4) Fam Hx Breast Cancer: genetics referral placed. The provider has submitted 99395 and 99213 mod 25. I feel as though many parts of the well woman overlap with the ov. Any thoughts will be greatly appreciated!

 

[TThivierge]

Hi Lb6731
This looks fine ...provider has stated the annual OB/GYN and pt has another problem vaginismus. The annual usually checking/screening for cancer of ovary or cervix. I believe you can put the modifier 25 on annual physical 99395. Ensure link dx to proper CPT.
I hope helped you just a bit more
Lady T

 

[cathyford]

Hello and thank you in advance. I am struggling with billing an office visit with a well woman. Here are abbreviated notes: Est female patient 32 years old 1) Annual Exam 2) Preconception Counseling: Discussed PNV ,offered carrier screening, 3) Vaginismus : Continue working with pelvic floor PT and vaginal estrogen and 4) Fam Hx Breast Cancer: genetics referral placed. The provider has submitted 99395 and 99213 mod 25. I feel as though many parts of the well woman overlap with the ov. Any thoughts will be greatly appreciated!

This depends on the payer and how long ago the patient was seen. Most often it is one or the other. Some times it gets paid. UHC will not pay for well-woman and an office visit.
When I do get them paid, I do the well-woman with a 25 modifier and then the E/M code but it needs to be a 99213. Also the patient hasn't been in for some time and then they want both...

 

[lsilbaugh]

I'm going to piggy back on this... I have a lot of annual visits and the patient will mention stress incontinence or may have an infection. the provider submits a new rx to treat it. would that be considered problem focused with the annual?

 

[boxford]

I'd be curious to know which dx codes are being used for the 99213. #2 and #4 on the list above would be included in the well women exam and not separately billable with an E/M. The vaginismus might be separately billable depending on the documentation. If the entire note for the problem is "Continue working with pelvic floor PT and vaginal estrogen" and I would say not billable, as the condition seems stable.