-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: coding From: Garry Siegel (garrys@mindspring.com) Tue Apr 24 22:06:49 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry Siegel: "GYN: recurrent abnormal paps" Previous message: Garry Siegel: "Re: Osteoporosis" In reply to: Joanne Bulley: "Re: coding" Next in thread: Zach Newton: "Re: coding" I don't have the CPT book handy, Bob, but I pretty much agree with Joanne. I would do a bit more on the exam so that you can code it as a preventive service at "full price", rather than a lesser service modifier. Conceptually, if you do less service, as you described, then coding it as a 99394 (depending on age) with the lesser service modifier -52 is correct. I do not see that using an E/M code would be justified or correct for wellness visits for pill refills. FWIW, for Medicare women who come in for an "annual exam", we bill 99395 (or whichever is for 65 and up--can't remember) -52 for lesser service, at a lesser price than an unmodified 99395, and bill the pelvic and breast component as G0101 or whatever special code Medicare has devised, at whatever price they pay. This way we don't "double bill" for the breast and pelvic component. Since Medicare does not pay for preventive services, but will pay for the breast and pelvic every 3 years (soon to be 2 as of 7/1/2001), we just bill it this way every time, and every 3 years we get the $28 from Medicare for the pelvic part, in addition to the fee for the 99395-52, which is paid by the patient at the time of service. They sign a waiver that states that they understand that preventive services aren't covered, but if their secondary covers it somehow, we'll refund/go by the insurer's rules. It is amazing how many of these folks aren't so happy about Medicare's lack of coverage for prevention, and how many want us to charge it as a problem--even though it is not. Pundits may wonder why we don't just do a breast and pelvic and pap for G0101. The answer is that these visits invariably expand into hormone talk, osteoporosis talk, check my BP please, etc., and that is worth more of my time than the G0101. So, if someone doesn't want the "full exam" and the charge for same, we don't see them. Right or wrong, that is what our group decided. Garry At Tue, 24 Apr 2001, Joanne Bulley wrote: > >It takes a minimum of time to do the rest to do the 99394 series of >codes. I find that I am the primary medical person that EVER checks on >the multisystem stuff and make sure she gets the multisystem preventive >care. Aslo- if you oversee the pap, stoll for occult blood, the >mammogram, the bone density and cholesterol or other testing - you or >your office staff does a lote of follow up in making sure she DID those >things and gets the results - so it is worth the additional fees. If >you do the multisystem review and exam and she doesn't need anything >else - due mostly to age - the fee and reimbursement happens to be less >for those ages. and the V72.3 diagnosis. I have had no problems with >this unless the patient has insurance that only covers E/M stuff. > >If the visit is TRULY medication management then the minimum code is the >level 3 (usually) in the E/M with the appropriate diagnosis for the >condition being managed. > >Many visits are indeed both at the same time - so it is appropriate to >code what "looks" the same as either "preventive" or "E/M" depending on >the insurer. I just make darn sure the notes are tight as to what is >being followed/managed/prevented etc! > >Joanne > >At Tue, 24 Apr 2001, Robert J Woolley wrote: >> >>Our office is having a minor disagreement about the proper way to code for >>routine annual gynecologic exams. For the moment, assume that one is doing >>just breast/pelvic exam, perhaps renewing an OC prescription, but no >>specific problems addressed otherwise--in other words, just preventive >>care. >> >>Are y'all using E/M codes for this? If so, at what level (typically), and >>what diagnostic code? Are any insurers requesting that it be done >>differently? >> >>Our coding specialist insists that these should be coded as preventive >>medicine visits (99394-99397, depending only on age), with a -52 modifier >>to indicate reduced service (since it's not a complete multisystem >>exam). Although I see the technical legitimacy of that theory, it ain't >>the way I've been doing it. Do any of you do it that way? > >-- >Joanne Bulley, MD, FACOG >Keene, NH, USA > -- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice Next message: Garry Siegel: "GYN: recurrent abnormal paps" Previous message: Garry Siegel: "Re: Osteoporosis" In reply to: Joanne Bulley: "Re: coding" Next in thread: Zach Newton: "Re: coding"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:48:11 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.