Author Topic: Billing/Coding a PE & a WW on same visit  (Read 176 times)

lpfamilyphys

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Billing/Coding a PE & a WW on same visit
« on: May 10, 2018, 11:34:25 AM »
I have a question about billing a Physical Exam and a Well Woman on the same visit.  It is my understanding that if both are done during the same visit the Preventive CPT would/should have both DX codes Z00.00 & Z01.41.  I have one provider that agrees with this billing practice and one that does not.  The provider thinks that Z00.00 should cover both on the CMS 1500 and documenting that a Well Women was done too should be enough in the note.    Any help would be great on this.  Thanks
« Last Edit: May 21, 2018, 01:40:46 PM by lpfamilyphys »

Michele

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Re: Billing a PE & a WW on same visit
« Reply #1 on: May 13, 2018, 08:03:42 PM »
Well the problem is that most claims are processed without the notes so just documenting it in the note may not be enough.  Services should be coded with the most accurate diagnosis for that service.  If a gynecological exam is being done then the dx Z01.41 seems to be the most accurate dx code.  But unless you are the coder you will have to go by what the dr says.  If you get denials you can show them that coding with the Z00.00 is causing the well woman to not be covered.
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lpfamilyphys

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Re: Billing/Coding a PE & a WW on same visit
« Reply #2 on: May 21, 2018, 01:53:26 PM »
I need help with information on the correct way to code this scenario.  Coding to the highest level of specificity is the end game for these claims. Our office does not have a coder, the providers do all of their own coding.  I would like to instruct the providers on the correct way of coding this issue.  We are not seeing any issues for 2018 with either way of coding/billing out these claims when it comes to reimbursement.  It will be for our 2019 reimbursement that this will have an impact on.  So if I can get the providers to code this correctly then there should be no issue with a lesser payment in 2019, as the fee schedules will be based on 2018 claim data.  Thanks for all of the help.  I have just come to a dead end in researching this issue.