Ben, NCCI considers Q0091 to be a column one code to the primary procedure 99396, meaning one service inherently includes the other. Assuming you are familiar with the code edits, I cannot think of a way to bill for the Q0091 code with the 99396. However, if you can justify an additional E&M code, eg: while performing the no diagnosis physical you find PID, you can justify performing the pelvic exam but billing using a focused exam, say 99212, billing the 99396 w V70.0 and the 99212-25 w dx for the PID.
Insurance sucks the life out of revenue, so I try to be as aggressive as possible whenever permissible. Hope this helps some, I've received a lot of help from forums so I want to be able to contribute back.
GDN
