gyn annual exam & sick visit

when a lady comes in for her annual pelvic & breast exam and complains of a vaginal, pelvic or breast issue and the doctor documents about it, can you bill an extra charge for the sick visit? I know to use the modifiers but is it legal?

Tx
Pam
pbarnett@whgobgyn.com

gyn annual exam & sick visit

did you physician document two separate notes in the chart (i.e. perform two separate and identifiable exams)? If so, you would use a preventative E/M and a E/M with -25 modifier (99213-25). What does your doctor's "assessment" say?

Gyn Annual Exam & Sick Visit

Does insurance make payment on both the E&M codes, even with the modifier? I don't think, they will make payment. Previously, when we billed E&M (99213-25) with an preventative E&M, the insurance has made the payment to the E&M and denied preventative E&M stating that payment has been included on the E&M.

Can anyone help me on that how reimberse both?

Annual gyn & sick visit

we are having no problem getting paid with the annual CPT® and well women ICD9 v72.31 ,then the sick visit with its' appropriate icd9 & modifier 25, my question is, is it legal to bill the sick visit if they are already examining these areas that are symptomatic?

annual / E&M

Most insurances will pay both. Usually the annual first then the E&M at 50% as a related visit. However not all insurances want the 25 modifier in the same place.
BCBS is 25 on E&M
Most of the rest want the 25 on both the annual and E&M. Good luck. Hope this helps.

annual plus sick visit

yes there is documentation and we have been billing w/the modifier & getting paid, but was told at a meeting that if the doctor was already doing a vaginal exam and the patient reports, menorrhagia-dysmenorrhea-vaginal dryness and doing a breast exam she reports a lump or painful breast, he then documents these symptoms and addresses them, sometimes prescriptions given, that it should be
included in the exam. Or does that "really" warrant a seperate charge when the docotor was already examining these areas?
tx

It absolutely deserves separate pay

but that does not mean the insurer will recognize that and pay it. As noted, the note should separate the medical decision making into preventative and problem and address separately.

gyn annual exam & sick visit

Yes, this is legal read the CPT® book in the e/m section, however the insurance companies does not recognize this rule.