# Preventative exams/pap/WWE



## sgormsen (Aug 11, 2010)

My physicians are following the guidelines in which a Pap is done every two years. Here's my delima. If a pap/pelvic exam is not done and just a breast exam, then it's my interpretation that this is just an Office visit 99213- 99215 and not the preventative E & M codes. My docs say that they can bill for example a 99395 with V76.2 & V72.31 because they are following these guidelines even though in the chart note under "genitalia" it says "Not Needed". If they are doing the pap/pelvic exam every 2 years then they should only be billing the preventative exam codes every two years. If I'm correct and I think I am, where can I find documentation to present to my Docs? Any help would be greatly appreciated.
thanks,
susan G


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## LLovett (Aug 11, 2010)

There is no requirement of any particular exam elements for 99381-99397, so I agree with your doctor.

These are age/gender based, so whatever the provider feels is appropriate pretty much goes.

Laura, CPC, CPMA, CEMC


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## sgormsen (Aug 11, 2010)

Ok, so my next concern is that the provider is wanting to use dx codes V76.2/routine cervical pap smear and V72.31/gyn exam, with or without pap, but the definition also includes the verbage "pelvic exam" in which they are not doing.  They are only doing a breast exam per the chart note.  Under "genatalia" they either write "deferred" or "not done".  What are your thoughts? I'm under the impression that if a breast exam is done only then it falls under 99212 - 99215 E & M?

thank you


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## LLovett (Aug 12, 2010)

I wouldn't use those dx, I woudl go with V70.0.

As far as the breast exam goes, what is the problem? If there is no problem, just a screening visit, you can't use problem ov codes 99212-99215. 

Laura, CPC, CPMA, CEMC


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