Case Studies in Coding: Coding for Medicare screening services

April 1, 2005

The Balanced Budget Act of 1997 provided coverage for certain screening services for Medicare beneficiaries. This did not include a comprehensive preventive medicine visit, but did incorporate some aspects of a well-woman examination. In the February issue, we looked at coding case studies involving preventive medicine services. This time, let's look at similar scenarios and how these services should be reported to Medicare.

The Balanced Budget Act of 1997 provided coverage for certain screening services for Medicare beneficiaries. This did not include a comprehensive preventive medicine visit, but did incorporate some aspects of a well-woman examination. In the February issue, we looked at coding case studies involving preventive medicine services. This time, let's look at similar scenarios and how these services should be reported to Medicare.

Helena's encounter Helena, an 83-year-old patient, is followed regularly for hypertension, Type 2 diabetes, and preventive care by her internist, Dr. Rousillon. He does not, however, perform well-woman exams but sends Helena to Dr. Bertram, a gynecologist, for her pelvic and breast exam and collection of a Pap smear. Dr. Bertram agrees to provide only these services because Helena is receiving ongoing care from Dr. Rousillon.

Magdalen's encounter Dr. Bertram's next patient is Magdalen, a 65-year-old who is scheduled for an annual exam. Dr. Bertram reviews the new patient history form that Magdalen has completed. The patient has no complaints and no gynecological issues and is seen by her family physician, Dr. Parolles, for management of mild, well-controlled hypertension. Dr. Bertram performs a complete physical examination, which is normal, and gives Magdalen Hemoccult cards to return to the office and a referral for a screening mammogram. He also discusses recommendations for gynecological screening services with her.

With these ideas in mind, how would you have coded these cases? Read on for the report of services and an explanation of the codes.