Female pt comes in, she would like to talk about birth control. We do all of the components of a well exam but no gyne exam for her as she already had that done one year ago. We bill 99395 with Z00.00. This is denied by a portion of our payers though because they only will not cover Z00.00 for a female.

I’m lost. I’ve checked with our payers but we all know they can’t tell us how to code. My doctor isn’t documenting counseling time, and most of our plans don’t cover 99401-99404 at a rate that is sustainable. $ 14.00 allowable for example for 99401.

99212 with Z30.09 causes many of our patients to be billed their copay or coinsurance because it isn’t being considered part of their preventive ACA benefits because we didn’t bill for 99395 or 99401 (example).

How should I be billing an office visit for birth control? What is everyone else doing for these? Should I be billing 99395 with Z30.09?