ghi insurance icd-9 code for annual gynecological exam

by Jerald Mayer DVM 6 min read

Full Answer

What is the ICD 9 code for routine GYN exam?

Short description: Routine gyn examination. ICD-9-CM V72.31 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V72.31 should only be used for claims with a date of service on or before September 30, 2015.

How do I Bill my annual GYN exam?

Just so, how do I bill my annual gyn exam? A gynecologic or annual women’s exam should be reported using the age-appropriate preventive medicine visit procedure code and a gynecological diagnosis code . How do you code a Pap smear procedure?

What is the ICD 9 cm code for diagnosis?

ICD-9-CM V72.31 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V72.31 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes).

What is the E&M code for gynecological exam?

The appropriate medical E&M office visit code (99201-99215) may be reported with modifier 25 in addition to the gynecological examination (G0101). If the reported service (s) do not meet the component requirements of the codes billed the services should not be billed. The patient’s medical record must contain:

Does Emblemhealth cover colonoscopy?

II) Preventive/Screening Colonoscopy A. Services provided by the in-network endoscopist, anesthesiologist and pathologist associated with an in-network preventive/screening colonoscopy are eligible for coverage without member cost-sharing.

What does GHI CBP mean?

GHI Comprehensive Benefits PlanThe GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors. You can see any network doctor without a referral. In most cases, when you see a network doctor, your cost will just be a copay. Using an Out-of-Network Health Care Professional.

Does Emblemhealth cover cologuard?

Those include a process called colonography; at-home tests, including Cologuard®*; and flexible sigmoidoscopy. Colon cancer screening is considered preventive care and most preventive screenings for colon cancer are covered by health insurance.

Is GHI the same as EmblemHealth?

Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 80 years, our mission is still the same: to create healthier futures for our customers and communities.

Is EmblemHealth GHI a PPO or HMO?

GHI HMO is available to City active employees and non-Medicare eligible retirees living in the five boroughs of New York City and the following New York State counties: Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Nassau, Orange, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, ...

How much does cologuard cost out of pocket?

The cost of Cologuard is around $500. Part of that cost may be covered by some insurances depending on your plan, co-pay, and deductible. Diagnostic testing is subject to deductibles and coinsurance. Screening colonoscopies are not subject to copays and deductibles and usually have no out-of-pocket costs for patients.

What is cologuard test?

Cologuard is a screening test for colon and rectal cancer. The colon sheds cells from its lining every day. These cells pass with the stool through the colon. The cancer cells may have DNA changes in certain genes. Cologuard detects the altered DNA.

Will Medicare pay for colonoscopy after cologuard?

A stool DNA test (Cologuard) will be covered by Medicare every three years for people 50 to 85 years of age who do not have symptoms of colorectal cancer and who do not have an increased risk of colorectal cancer.

What is GHI CBP optional rider?

OPTIONAL RIDER – ENHANCED SCHEDULE FOR OUT-OF-NETWORK MEDICAL/PHYSICIAN SERVICES PROVIDED. THROUGH GHI-EMBLEM HEALTH. Enhanced schedule increases the reimbursement of the basic program's non-participating provider fee schedule, on average, by 75%.

What is GHI in salary?

A group health insurance (GHI) is a health insurance plan that covers a group of people (and their family members) who work in the same organization. As we discussed here, GHI is 10X better than an individual health insurance.

Is GHI accepted in Florida?

States with the most GHI Doctors: New Jersey. Connecticut. Pennsylvania. Florida.

What is the GHI deductible for 2020?

You will continue to have a $25 annual deductible for private duty nursing (PDN), durable medical equipment (DME), and ambulance services. Your annual maximum benefit for all three services is $2,500.

What is the modifier for a Pap smear?

If a physician performs a Pap Smear (obtaining the specimen, preparing the slide, and conveyance - Q0091) and an unrelated, separately identifiable E/M on the same day both services may be billed. The appropriate medical E/M office visit code (99201-99215) may be reported with modifier 25 in addition to Q0091. If the reported service(s) do not meet the component requirements of the codes billed the services should not be billed.

What is BCBSND reimbursement policy?

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.

When a physician performs a systemic physical examination as part of an annual gynecological?

When a physician performs a systemic physical examination as part of an annual gynecological examination and provides an unrelated , separately identifiable E/M on the same day both services may be billed. The appropriate medical E/M office visit code (99201-99215) may be reported with modifier 25 in addition to the gynecological examination (G0101). If the reported service(s) do not meet the component requirements of the codes billed the services should not be billed.

What is routine claim editing logic?

Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity. Mandated or legislative required criteria will always supersede. In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

Does Blue Cross Blue Shield of North Dakota have E/M?

Blue Cross Blue Shield of North Dakota (BCBSND) has identified an increase in providers unbundling Preventive Evaluation and Management (E/M) and/or Gynecological Screening services. The claims reviewed include additional service which are inherent components of the codes such as pap smear collection or digital rectal examinations. The below billing guidelines are provided to educate providers on correct billing.

Can a preventive E/M be performed on the same day?

Providers should only report the Preventive E/M when rendering a gynecological and systemic preventive annual E/M service.

Which criteria will always supersede?

Mandated or legislative required criteria will always supersede.

What is a periodic comprehensive preventive medicine?

Periodic comprehensive preventive medicine reevaluation and management of an individual includes an age- and gender-appropriate history; physical examination; counseling, anticipatory guidance, or risk factor reduction interventions; and the ordering of laboratory or diagnostic procedures.

What is the CPT code for preventive medicine?

Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402 are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction interventions, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a pre existing problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, Oxford will reimburse the Preventive Medicine service plus 50% the Problem-Oriented E/M service code when that code is appended with modifier 25. If the Problem-Oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.existing problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, Oxford will reimburse the Preventive Medicine service plus 50% the Problem-Oriented E/M service code when that code is appended with modifier 25. If the Problem-Oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.

What is a 99391?

99391 – Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) – Average fee amount $90

What is the primary diagnosis code for HCY?

Providers must use V20.2 as the primary diagnosis on claims for HCY screening services. There are two exceptions. CPT codes 99381EP and 99391EP must be billed with diagnosis code V20.2, V20. 31 or V20 .32. CPT codes 99385 and 99395 must be billed with diagnosis code V25.01-V25.9, V70.0 or V72.31.

What is a CPT 4 exam?

A preventive medicine exam, as described by CPT-4 codes (99384 – 99397), includes a comprehensive age and gender appropriate history, examination, counseling/anticipatory guidance/risk-factor reduction interventions, and the ordering of appropriate immunization (s) and laboratory/diagnostic procedures.

What is CPT in nutrition?

According to CPT, for Medical Nutrition Therapy assessment and/or intervention performed by a physician, report Evaluation and Management or Preventive Medicine service codes.

What is modifier 25?

Modifier-25 should be added to the Office/Outpatient code to indicate that a significant; separately identifiable E&M service was provided by the same physician on the same day as the preventive medicine service. Note: An insignificant or trivial problem or abnormality that is encountered in the process of performing the preventive medicine E&M service and which does not require additional work and the performance of the key components of a problem-oriented E&M service should not be reported.