Preventive Medicine Service - Articles
Preventive ServicesApril 26th, 2022 - Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT
In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding...
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2021
How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
2019
Vaccine Administration - When The Right Vaccine Code is Not Enough
September 30th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
September 30th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...
2018
CMS: Medicare Diabetes Prevention Program Expanded Model
November 1st, 2018 - Find-A-Code
May 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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CMS announces the Medicare Diabetes prevention program is now a new covered service. Per a recent MLN news release. Medicare Beneficiaries will be notified in 2019 in a Medicare handout. Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately...
AMA vs Medicare rules and the use of the PT modifierMay 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...
Preventive Medicine: Alcohol Misuse Screening & CounselingMay 9th, 2018 - Find-A-Code™
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// Alcohol Misuse Screening and Counseling
Procedure Codes G0442: Annual alcohol misuse screening, 15 minutes G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes 99408: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to ...
Preventive Medicine: Annual Wellness VisitMay 9th, 2018 - Find-A-Code™
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Annual Wellness Visit
Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...
Preventive Medicine: Bone Mass MeasurementsMay 9th, 2018 - Find-A-Code™
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Bone Mass Measurements
Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...
Preventive Medicine: Breast Cancer Genetic ScreeningMay 9th, 2018 - Find-A-Code™
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Breast Cancer Genetic Screening
Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...
Preventive Medicine: Breastfeeding SuppliesMay 9th, 2018 - Find-A-Code™
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Breastfeeding Supplies
Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session
ICD-10-CM ...
Preventive Medicine: Cardiovascular Disease Screening TestsMay 9th, 2018 - Find-A-Code™
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Cardiovascular Disease Screening Tests
Procedure Codes 80061: Lipid panel. This panel must include the following:
Cholesterol, serum, total
Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
Triglycerides
82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...
Preventive Medicine: Cervical Dysplasia ScreeningMay 9th, 2018 - Find-A-Code™
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Cervical Dysplasia Screening
Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...
Preventive Medicine: Colorectal Cancer ScreeningMay 9th, 2018 - Find-A-Code™
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Colorectal Cancer Screening
Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...
Preventive Medicine: Contraceptive MethodsMay 9th, 2018 - Find-A-Code™
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Contraceptive Methods
Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...
Preventive Medicine: Counseling to Prevent Tobacco UseMay 9th, 2018 - Find-A-Code™
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Counseling to Prevent Tobacco Use
Procedure Codes 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
ICD-10-CM 99406-99407: No specific diagnoses
Frequency 99406-99407: 2 attempts a year, ...
Preventive Medicine: Dental Caries in ChildrenMay 9th, 2018 - Find-A-Code
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Dental Caries in Children
Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional
ICD-10-CM 99188: No specific diagnoses
Frequency 99188: No specific frequency guidelines
Additional Information 99188
Covered for children from birth until their seventh birthday
Find-A-Code™ - Preventive Services - The information ...
Preventive Medicine: Depression ScreeningMay 9th, 2018 - Find-A-Code™
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Depression Screening
Procedure Codes G0444: Annual depression screening, 15 minutes 96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
ICD-10-CM G0444, 96127: No specific diagnoses
Frequency G0444:Once annually 96127: No specific frequency guidelines
Additional Information 96127
Only covered for ages ...
Preventive Medicine: Diabetes ScreeningMay 9th, 2018 - Find-A-Code™
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Diabetes Screening
Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...
Preventive Medicine: Diabetes Self-Management TrainingMay 9th, 2018 - Find-A-Code™
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Diabetes Self-Management Training
Procedure Codes G0108: DSMT, individual, per 30 minutes G0109: GDSMT, group (2 or more), per 30 minutes
ICD-10-CM G0108-G0109: Contact payer for more specific guidelines
Frequency G0108-G0109
Initial year: Up to 10 hours of initial training within a continuous 12-month period
Subsequent years: Up to 2 ...
Preventive Medicine: General ProceduresMay 9th, 2018 - Find-A-Code™
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General Procedures
Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List ...
Preventive Medicine: Glaucoma ScreeningMay 9th, 2018 - Find-A-Code™
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Glaucoma Screening
Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
ICD-10-CM G0117-G0118: Z13.5
Frequency G0117-G0118: Once a year
Additional information G0117-G0118
Coverage as is indicated with ...
Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and AdministrationMay 9th, 2018 - Find-A-Code™
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Hepatitis B Virus (HBV) Vaccine and Administration
Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...
Preventive Medicine: Hepatitis C Virus (HCV) ScreeningMay 9th, 2018 - Find-A-Code™
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Hepatitis C Virus (HCV) Screening
Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...
Preventive Medicine: Human Immunodeficiency Virus (HIV) ScreeningMay 9th, 2018 - Brandon Herman, QCC
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Human Immunodeficiency Virus (HIV) Screening
Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ...
Preventive Medicine: Human Papilomavirus (HPV) Vaccine and ScreeningMay 9th, 2018 - Find-A-Code™
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Human Papilomavirus (HPV) Vaccine and Screening
Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...
Preventive Medicine: Influenza Virus Vaccine and AdministrationMay 9th, 2018 - Find-A-Code™
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Influenza Virus Vaccine and Administration
Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...
Preventive Medicine: Initial Preventive Physical ExaminationMay 9th, 2018 - Find-A-Code™
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Initial Preventive Physical Examination (Medicare Only)
Procedure Codes G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation ...
Preventive Medicine: Links and ResourcesMay 9th, 2018 - Find-A-Code™
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References
Kaiser Permanentehttps://provider.ghc.org/open/coverageAndEligibility/groupHealthPlans/preventive-services-guidelines.pdf
Medicare Learning Networkhttps://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnlywithICD9.pdf
AAFP - ICD-10 Simplifies Preventive Care Coding, Sort Of - Cindy Hugheshttps://www.aafp.org/fpm/2014/0700/oa1.html
List of ACA Preventive Services and CPT Codes - STDshttp://stdtac.org/wp-content/uploads/2014/06/List-of-ACA-Preventative-Services-and-CPT-Codes-_STDTAC.pdf
Additional Links and Resources
ACA guidelines as per healthcare.govhttps://www.healthcare.gov/coverage/preventive-care-benefits/
Preventive Medicine Listhttps://www1.ghc.org/static/pdf/public/formulary/aca-list.pdf
...
Preventive Medicine: Lung Cancer ScreeningMay 9th, 2018 - Find-A-Code™
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Lung Cancer Screening
Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...
Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity PreventionMay 9th, 2018 - Find-A-Code™
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Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...
Preventive Medicine: Newborn Screenings/TestsMay 9th, 2018 - Find-A-Code™
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Newborn Screenings/Tests
Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...
Preventive Medicine: Pneumococcal Vaccine and AdministrationMay 9th, 2018 - Find-A-Code™
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Pneumococcal Vaccine and Administration
Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
ICD-10-CM G0009, ...
Preventive Medicine: Prostate Cancer ScreeningMay 9th, 2018 - Find-A-Code™
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Prostate Cancer Screening
Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA)
ICD-10-CM G0102-G0103: Z12.5
Frequency G0102-G0103: Once annually
Additional Information G0102-G0103
Only for males aged 50 and older
G0102
Copayment and deductible may apply, consult your payer
Find-A-Code™ - Preventive Services - ...
Preventive Medicine: Screening Children for Visual AcuityMay 9th, 2018 - Find-A-Code™
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Screening Children for Visual Acuity
Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral
ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101
Frequency 99173: No specific frequency guidelines
Additional Information 99173
Not covered by Medicare for preventative care
Some policies will only cover as preventive for children, consult your payer
Find-A-Code™ - Preventive ...
Preventive Medicine: Screening for AnemiaMay 9th, 2018 - Find-A-Code™
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Screening for Anemia
Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel
ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...
Preventive Medicine: Screening for STIs & HIBC to Prevent STIsMay 9th, 2018 - Find-A-Code™
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Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
Procedure Codes 86592: Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 86593: Syphilis test, non-treponemal antibody; quantitative 86631: Antibody; Chlamydia 86632: Antibody; Chlamydia, IgM 86780: Antibody; Treponema pallidum 87110: Culture, chlamydia, any source ...
Preventive Medicine: Screening Gynecological ExaminationMay 9th, 2018 - Find-A-Code™
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Screening Gynecological Examination
Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient
ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...
Preventive Medicine: Screening MammographyMay 9th, 2018 - Find-A-Code™
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Screening Mammography
Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...
Preventive Medicine: Screening Pap TestsMay 9th, 2018 - Find-A-Code™
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Screening Pap Tests
Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...
Preventive Medicine: Therapy for Fall PreventionMay 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page
Therapy for Fall Prevention
Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...
Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...
Preventive Medicine: Use of Modifier 33May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page
The Use of Modifier 33
Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only, it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier.
...
Preventive Medicine with a New PatientJanuary 9th, 2018 - Find-A-Code
When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required.
New Patient: A patient that has not received any professional services i.e., E&M or any other face to face service from the physician or group within the ...
2017
Medicare Diabetes Prevention Program (MDPP) Expanded Model Information
December 12th, 2017 - Jared Staheli
December 12th, 2017 - Jared Staheli
Diabetes treatment places an ever-increasing strain on the resources of the U.S. healthcare system. CMS estimated that in 2016 alone, Medicare incurred an additional $42 billion in costs due to the number of beneficiaries with diabetes. The best way to keep these costs down in the future is by preventing ...
2015
Sports Physicals
July 27th, 2015 - Codapedia Editor
June 1st, 2015 - Codapedia Editor
March 17th, 2015 - George Lawson
January 30th, 2015 - Codapedia Editor
July 27th, 2015 - Codapedia Editor
Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope.
If the patient presents for a well child visit, and also needs their camp physical filled out, it is pretty easy. Perform...
Preventive medicine and office visit, same dayJune 1st, 2015 - Codapedia Editor
Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam
Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are:
• The description given by CPT® for “annual physicals”
•...
All About Screening and Diagnostic MammogramsMarch 17th, 2015 - George Lawson
When billing for mammograms, documentation must include the purpose and the result of the procedure. Two major purposes of mammogram are diagnostic and screening. It can also be used mammography to guide other procedures.
Tip 1: Confirm the Purpose
Determine the purpose of the procedure; i.e....
Preventive medicine service and office visit on the same dayJanuary 30th, 2015 - Codapedia Editor
Modifier 25 for Preventive medicine service and office visits
The CPT® book describes modifier 25 as the modifier to be used on an E/M service when "a Significant, Separately Identifiable Evaluation and Management Service” is performed by the same physician on the same day of the...
2014
Flu vaccine code changes coming in 2014
January 30th, 2014 - Scott Kraft
January 30th, 2014 - Scott Kraft
Prepare now for a handful of changes coming to the way you code for influenza vaccinations in 2014. Getting paid successfully, however, may require you to hold onto some claims for longer than you would ordinarily like.
CMS has directed the Medicare Administrative Contractors (MACs) to pay for...
2013
Wellness visits for Medicare patients
November 18th, 2013 - Codapedia Editor
September 18th, 2013 - Scott Kraft
April 24th, 2013 - Codapedia Editor
November 18th, 2013 - Codapedia Editor
Dec 20, 2010 Added Medicare's MLN Matters article as a resource.
Hold the champagne--it's true that Health Care Reform added an annual "wellness"visit for every beneficiary, but it's not what you or your doctors think of as an annual exam. In fact, it's has more in common with the...
Influenza vaccine payments amounts released for 2013-2014September 18th, 2013 - Scott Kraft
CMS has released the coding and payment information for the 2013-2014 flu vaccine season. As flu season kicks into overdrive, it seems like a good time to review payment rules for the flu shot.
Most insurance payers will cover one flu shot per flu season. The Affordable Care Act (ACA) requires...
Medicare Wellness Visits--updateApril 24th, 2013 - Codapedia Editor
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2009
Colonoscopy
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Colonoscopy
Screening versus diagnostic—Medicare patients
Medicare develops HCPCS codes for some preventive medicine services when it wants to differentiate between a diagnostic test (which has a CPT® code) and a screening test. Colonoscopy is a good example. There are a series of...
G0101 Pelvic and breast examJuly 6th, 2009 - Codapedia Editor
Medicare does not pay for routine physical exams annually for patients--a sore spot for Primary Care Providers and Medicare beneficiaries alike. They do pay for an initial Welcome to Medicare visit. (See the Codapedia article about that topic.)
Medicare does pay for a screening pelvic and breast...
How do I bill for a PAP smear?April 22nd, 2009 - Codapedia Editor
Physicians often ask what codes to use in order to bill for a pap smear provided during a preventive medicine service or other E/M service. The only CPT® codes for pap smears are for Pathologists, for the physician interpretation of the cytology specimen.
So, what does the GYN or primary care...
How to bill for Well Woman Exams (WWE)April 15th, 2009 - Charlene Burgett
Well Woman Exam Coding
There are options for billing pelvic exams and Pap smears for non-Medicare payers, albeit inconsistently by health plan. Some health plans will pay G0101, Q0091, S0610 and/or S0612. Some will pay one or another, some will pay a combination of two, others will pay certain...
Preventive Medicine Services for Medicare PatientsApril 10th, 2009 - Codapedia Editor
The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening...
Screening Diabetes tests for Medicare patinetsMarch 31st, 2009 - Codapedia Editor
The Medicare Modernization Act of 2003 added a benefit for Medicare patients for services provided after Jan 1, 2005. Medicare added coverage for screening Medicare patients for diabetes, if the patient has an individual risk for diabetes. There are diagnosis and frequency limitations.
The...
Visual Acuity Screening March 12th, 2009 - Codapedia Editor
Many physician practices are denied by third party payers when billing for a visual acuity test with a well child visit. The code for visual acuity testing is 99173. See the CPT® book for a complete definition of this code. This is a screening test of visual acuity, quantitative, bilateral,...
Billing for a breast examMarch 9th, 2009 - Codapedia Editor
Sometimes, a patient presents only for a breast exam, perhaps prior to a mammogram. Is that a separately billable service?
Newly found lump: A patient who presents with a newly discovered lump and presents to the office can be billed with new or established patient visit codes (depending on the...
Can prolonged services be added to preventive medicine codes?March 9th, 2009 - Codapedia Editor
There are two sets of prolonged services codes, one set for face-to-face additional time spent with the patient in the office or hospital, and one set for non-face-to-face time. Non-face-to-face time is typically not paid by most insurers. In 2009, CPT® changes its description of these...
AAA screeningMarch 2nd, 2009 - Codapedia Editor
Medicare allows screening for Abdominal Aortic Aneurysm in very limited situations.
The screening must be ordered as part of the patient's Welcome to Medicare visit (Initial Preventive Physical Exam). That limits the screening to newly enrolled Medicare patients. If the patient has not had the...
Welcome to Medicare VisitJanuary 29th, 2009 - Codapedia Editor
Welcome to Medicare
Initial Preventive Physical Examination (IPPE)
A new benefit under the Medicare Modernization Act
Effective date 1-1-05, changes for 2009
Eligibility: Any Medicare beneficiary who enrolls in Medicare on or after January 1, 2005
Time limits: Eligible for benefit in the...
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Acupuncture|Alternative (10)
Allergy|Immunology (10)
Anesthesia|Pain Management (26)
Audits/Auditing (126)
Behavioral Health|Psychiatry|Psychology (27)
Benchmarks (11)
Billing (221)
Bundling (6)
Cardiology|Vascular (27)
Chiropractic (93)
Claims (72)
Coding (274)
Collections (38)
Colonoscopy (3)
Compliance (128)
Covid-19 (30)
CPT® Coding (279)
Denials & Denial Management (48)
Dental (58)
Dermatology|Plastic Surgery (9)
Diagnosis Coding (147)
Diagnostic Testing (12)
DME|Supplies|Equipment (23)
Documentation Guidelines (120)
Drugs|Pharmaceuticals|FDA (23)
E-prescribing (4)
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Evaluation & Management (E/M) (149)
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Home Health|Hospice (28)
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ICD-10-PCS (1)
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Internal Medicine (10)
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Medicaid (14)
Medical Records (10)
Medicare (226)
Medicare Advantage (16)
Medicare Claims Processing Manual (5)
Medicare Physician Fee Schedule (MPFSDB) (22)
MIPS|PQRS|PQRI (32)
Modifiers (135)
National Coverage Determinations (NCD) (8)
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Ophthalmology (12)
Optometry (12)
Oral and Maxillofacial Surgery (30)
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Pediatrics (13)
Physical Medicine|Physical Therapy (58)
Physicians (13)
Podiatry (17)
Practice Management (117)
Preventive Medicine Service (64)
Primary Care|Family Care (60)
Pulmonology (12)
Radiology (11)
Reimbursement (56)
Relative Value Units (RVUs/RBRVS) (9)
Rheumatology (7)
Risk Adjustment (9)
Screening (5)
Skilled Nursing (20)
Specialty Coding (30)
Surgical Billing & Coding (49)
Teaching Physician Rules (4)
Transitional Care Management (TCM) (2)
Urology|Nephrology (9)
Wound Care (1)