WPSI Coding Guide
The Patient Protection and Affordable Care Act (ACA) requires most private health care plans (large and small group, and individual plans including Affordable Care Act’s (ACA) Marketplace plans) to cover preventive services supported by HRSA put forth by the Women’s Preventive Services Guidelines, without charging a copayment or coinsurance, for those who use in-network providers.
The Women’s Preventive Services Initiative (WPSI) Coding Guide acts as guidance to assist practices with coding and billing preventive services for women and was developed in consultation with staff of the American College of Obstetricians and Gynecologists (ACOG). This guide provides all the information healthcare providers need to properly code for WPSI Recommendations, including ICD-10 codes, Medicare, and Medicaid resources.
CPT coding guidelines state that the code selected must be the most accurate description of the service provided and be consistent with coding conventions and guidelines. Failure to submit accurate codes may result in improper billing, payer audits, and denied reimbursement.
Coding information for each WPSI recommendation:
- Breast Cancer Screening for Average-Risk Women
- Breastfeeding Services and Supplies
- Screening for Cervical Caner
- Screening for Anxiety
- Screening for Diabetes Mellitus After Pregnancy
- Screening for Gestational Diabetes Mellitus
- Screening for Human Immunodeficiency Virus Infection
- Screening for Interpersonal and Domestic Violence
- Counseling for Sexually Transmitter Infection
- Screening for Urinary Incontinence
- Well-Woman Preventive Visits
Disclaimer and Copyright Notices
All diagnosis codes referred to in Women’s Preventive Services Initiative (WPSI) Coding Guide were excerpted from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), October 2019 revision, published by the United States government under the auspices of the ICD-10-CM Coordination and Maintenance Committee.
Current Procedural Terminology (CPT), Fourth Edition, copyright 2019 American Medical Association (AMA). All rights reserved. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.
CPT is a registered trademark of the American Medical Association.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UHOMC29940, Bright Futures for Women’s Health: Standard Practice Guidelines for Well-Women Care. This information or content and conclusions are those of the author and should not be construed as the official position nor policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.
This book is provided by the American College of Obstetricians and Gynecologists (ACOG) for educational purposes only. It is not intended to represent the only, or necessarily the best, coding format or method for the situations discussed, but rather as an approach, view, statement, or opinion that may be helpful to individuals responsible for diagnosis and procedure coding. The statements made in this publication should not be construed as ACOG policy or procedure, nor as standards of care. The American College of Obstetricians and Gynecologists makes no representations or warranties, expressed or implied, regarding the accuracy of the information contained in this book and disclaims any liability or responsibility for any consequences resulting from or otherwise related to any use of, or reliance on, this book. Please reference the CPT.