Wwe & problem

I have a new patient that came in for Well woman exam and also had irregular bleeding on depo provera. The pap smear could not be performed due to the irregular bleeding. The doctor did a physical exam breast and pelvic and discussed with the patient irregular bleeding causes and treatment and gave her rx for birth control. I coded the visit a new patient problem visit with irregular bleeding. My question is this insurance generally will not cover well woman unless a pap is done.
So what do I do?

Help!
Cobgyn

question

This is obviously a commercial payer. A well woman exam is usually billed with code range 99381-99397. It includes all age appropriate exams and risk factor discussions. Note why the PAP was deferred and when she comes back in for PAP only, there is a no charge (included in well codes as is the breast and pelvic). What have you billed or are attempting to bill?

Documentatio and Medical Necessity

A 30-year-old established patient presents for her well-woman examination.Physician takes the patient’s interval medical, family and social history and perform a complete review of systems. The physician also examines the patient that includes a blood-pressure check and thyroid, breast, abdominal and pelvic examinations, and unless contraindicated a Pap smear. The patient states she is on oral contraceptives and has concerns about intermittent break-through bleeding. The physician counsels the patient regarding alternatives and gives her a prescription for a new medication. Also discussed with the patient is diet, exercise, substance abuse and sexual activity. Although the patient has concerns about her current method of birth control, the associated counseling and change in medication is considered part of the preventive medicine service for her age group, so code 99395, “Periodic comprehensive preventive medicine ..., established patient; 18-39 years,” and ICD-9 code V72.3, “Gynecological examination.”

But, if the patient comes into the office for a routine preventive examination and also has significant new complaints (e.g., chest pain or irregular bleeding) the visit may become a combination of preventive and problem-oriented care. As long as each service is clearly documented and distinct from the documentation of the preventive service, CPT suggests submitting a preventive medicine services code (99381-99397) for the routine exam and the appropriate office visit code (99201-99215) with modifier -25, “Significant, separately identifiable [E/M] service by the same physician on the same day of the procedure or other service,” attached to the problem-oriented service.

preventive and office visit

Take a look at:

http://www.codapedia.com/-article_63_.cfm

http://www.codapedia.com/-article_208_.cfm

re: preventive and office visit

[Take a look at:

http://www.codapedia.com/-article_63_.cfm

http://www.codapedia.com/-article_208_.cfm

]