Medicaid Well Woman Exam

Coding Medicaid well woman exams has been a topic of discussion for years. For some reason, I just cannot grasp the rules. I’ve been coding the 9939 series for the actual exam, and corresponding Z01.419 OR Z01.411 for commercial carriers. However, Missouri Medicaid does not like the 9939 series, nor do they like Z01.419 for patients under 18 years of age… In replace of 9939, we’re coding 9921 series which are not a problem. The problem comes with the 1CD-10 as they’re requesting a child routine exam code, such as Z00.129, but this does not apply to an actual well woman exam. What ICD-10 should be used for patient’s under 18?

re: Medicaid Well Woman Exam

Check your Medicaid policy manual . Here in SC there are limited benefits for Medicaid patients that do not meet the poverty guidelines to qualify for full benefits. These patients do qualify for preventive services and the codes to use are G0438 or G0439.