Forum - Questions & Answers

Jan 27th, 2016 - sschwartz 4 

Physical exam

How do I code a physical/wellness exam in which the provider does all but the breast & pelvic/pap on one visit and has the patient come back a week later for the breast & pelvic/pap? Patient was on her period at time of her physical. Her insurance is Premera Blue Cross and only allows one annual physical a year. She actually only came in for the physical due to needing it to proceed with an adoption and it's paperwork. The insurance won't allow an E&M with a preventive DX such as Z00.00 or Z01.419; at least I know we have had denials in the past for trying that combo. I just totally unsure of how to bill this situation; any advice?

Jan 27th, 2016 - ladyt 10 

re: Physical exam

I would have the pt check with BCBS but isn't a WWE covered at 100% on most plans? If anything she should have probably paid for the CPE as an E/M with copay, because it was for admin purposes. Her plan can explain it all to her. She may owe a copay/coinsurance.

Feb 2nd, 2016 - Codapedia Editor 1,399 

re: Physical exam

I think the first visit is correctly billed as a 9939X. Many groups don't bill the second. You can try with Q0091 and G0101.

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