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Tag Archives: preventive

Preventive Exam and History of Positive HPV

Posted on by
Hello All

I have a few patients who calls and complains because they have received a bill from the labs showing they owe money. the patient was seen in our office for their yearly Preventive exam in which I would bill out the 99385-99397 with the Z01.419 (Encounter for gynecological examination (general) (routine) without abnormal findings). I have learned that on the providers side when they submit the Lab codes they are using things like R87.612 (Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)) because in the previous years the patients labs came back abnormal; as for when they have their colpo in the previous year.

So because the provider is putting a problem diagnosis on the lab claim this is where the patients bill is coming from.

I would like to know is this correct billing when submitting claims to the lab??? Or should they be using Z01.411 (Encounter for gynecological examination (general) (routine) with abnormal findings) because we truly do not know if the patient is reflecting positive until the labs come back for this year.

Thanks in advanced

Bev

Medical Billing and Coding Forum

Preventive coverage for sterilization procedure 58661

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I work for a payer in Idaho and we’re seeing more and more providers performing CPT 58661 lap removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) for sterilization purposes. Our members are not aware that this procedure isn’t considered a tubal ligation/ and is not required to be covered as a preventive services according to the ACA requirements for Prescribed Contraceptive Services, which would be covered without cost sharing if performed by an in-network provider and the plan is ACA compliant.

My question is are other commercial payers/carriers, particularly in Idaho, covering 58661 without cost-sharing as a preventive service if performed by an in-network provider and the plan is ACA compliant?

Thanks,
Corinne A. Littleton, CPC
The truth doesn’t mean anything, it just is.

Medical Billing and Coding Forum

Preventive or problem-focused visit, this is a different scenario

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Not sure how to code this visit. 9 year old patient had a well child visit on 07/30/2018, but would not let the female provider perform the genitourinary exam due to history of sexual abuse. Returned on 08/08/2018 to have this exam performed by a male provider. Male provider also explained puberty and physical changes the patient would be experiencing in the next few years. Does this warrant a preventive visit or problem-focused? Can we code a preventive visit that soon? Can I code a problem focused e/m with Z00.3 and Z62.010. Any thoughts would be greatly appreciated.

Medical Billing and Coding Forum

AWV, Preventive visit, office visit

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Looking for information regarding reporting an AWV, preventive and office visit on the same DOS. I have started seeing this some with providers and wondering if these three codes can be reported on the same DOS. I have not been able to find much information about it and would appreciate any advice I could get on this and if there any resources or guidelines.

Thank you.

Medical Billing and Coding Forum

TriCare denies 99402 Clinical Preventive Services

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Our office was denied payment for 99402 for a TriCare patient. Denial was that this is a non-covered service but the most current update of the TriCare Manual 6010.60-M section 2.1 and 2.2 state clinical preventive services are covered with no cost sharing and 99402 is listed as an allowable code.
Any ideas? Thoughts?
Thank you,
Marcia Cox

Medical Billing and Coding Forum

Preventive Exams Medicare patients

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We have a situation where "preventive health care" and "preventive examinations" are scheduled for Medicare patients. Medicare denies payment, of course, and we are asked to code the visit to an established E&M code, because the Medicare IPPE and Annual Wellness Exam components are not met.

I may be thinking way too much, but when I see verbiage as [presents for] "preventive health care"; "patient here for check-up"; presents for "physical examination" my first thought is to be wary on changing the CPT code from a preventive to a problem-driven E&M code.

The documentation has minor problems notated in the A&P, all established problems. To me, these established problems, would not warrant a problem-driven E&M code, as I feel they are minor components and would be bundled with the preventive exam codes.

I’m stuck here. Does anyone have any suggestions on this? We are working to educate the providers and staff, which is a positive step! But I don’t feel these visits should be changed. Is there any acceptable reasons that the visit can be changed from a preventive code to a problem-driven CPT code?

Thanks,
Beth

Medical Billing and Coding Forum

Preventive Medicine Services & Office/Outpatient

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I have an OB visit that was denied. A 99385 was billed for a new patient along with 99213-25 on the same day. The 2018 CPT book states on page 36 that if a problem or abnormality is significant enough to require additional work, then the appropriate Office/Outpatient code 99201-99215. Can 99203-25 be billed with the 99385 since it is the same date of service and it is a new patient? Or is only one "new patient" procedure code allowed? Insurance denied Z31.41 with the 99213-25 even though the additional time spent was for infertility testing.

Any help is greatly appreciated! :)

Medical Billing and Coding Forum

Quality ID #134 (NQF 0418): Preventive Care and Screening: Screening for Depression a

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I want to be sure that I am interpreting this measure correctly.

For Denominator Exclusion the definition:
‘Not Eligible for Depression Screening or Follow-Up Plan (Denominator Exclusion) –
• Patient has an active diagnosis of depression prior to any encounter during the measurement period- F01.51, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.1, F34.81, F34.89, F43.21, F43.23, F53, O90.6, O99.340, O99.341, O99.342, O99.343, O99.345
• Patient has a diagnosed bipolar disorder prior to any encounter during the measurement period- F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9′

‘Depression Screening or Follow-Up Plan not Documented, Patient not Eligible
Denominator Exclusion: G9717: Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required

I do not see that I HAVE TO HAVE AN ICD10 CODED PRIOR to any encounter. I see the list of ICD 10 as examples of codes to reference. We screen the patient for Depression as we do provider Narcotics. So if we already have a patient seen in our clinic with a Personal Medical History of Depression or Bioplar disorder can I use G9717, even with out ICD10 being submitted by our office prior to this performance period.

Thank you in advance for your help :)

Justina L. , CPC, CPB

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Medical Billing and Coding Forum