# Non-Medicare GYN Exam codes?



## theaterd (Jul 16, 2014)

I am being asked to find what codes to bill for annual/bi-annual ob/gyn exam.  I guess these providers originally billed Preventative codes (99395-99397) and got denied because patients are getting annual physicals at their PCP.

If a patient (non-Medicare) needs a PAP test or a bi-annual exam, what codes do you use??

I have no experience in OB/GYN, so ANY help is greatly appreciated.

Thank you


----------



## debrakae (Jul 16, 2014)

It is based on the diagnosis. For a non-Medicare GYN, our office billes V72.31 (routine GYN exam) and V76.2 (routine PAP smear) instead of the V70.0 (routine medical exam). We use CPT code 99381 - 99397 for both.


----------



## theaterd (Jul 17, 2014)

Thanks for the quick response, debrakae, however I'm still unclear on what cpt code to use if the 99381-99397 has already been used by their PCP.  Is there a code, or do you hope that the patient has a complaint so you can bill a 99201-99215?


----------



## tlm5506 (Jul 17, 2014)

I have the exact same issue where I work. I bill for 3 OB/GYN doctors and am wondering if the annual/preventative codes are really the right codes to use for these type of exams. Also, if a patient is a teenager they are not doing a pap smear. So is the annual/preventative codes really the right code to use for this exam when no pap smear is done? And it's not just teenagers all the time; sometimes the doctors will not do a pap smear due to the cervical screening guidelines. They have been using the V72.31 diagnosis code and an annual/preventative CPT code. 
Any help would be appreciated.
Thanks.


----------



## tlm5506 (Jul 17, 2014)

Another issue I encountered was a patient scheduled an "annual exam" with the OB/GYN doctor. When the doctor was with the patient it was determined that the patient didn't need a pelvic and a pap smear. The exam was limited. The doctor insists this was still an "annual" exam and coded it as such. I'm not sure what to do in this instance.


----------



## debrakae (Jul 17, 2014)

Females are allowed 2 preventative visits per year. Usually one is done by the PCP with the diagnosis of V70.0 and the second is done by the GYN with the diagnosis of V72.31 and V76.2 (only of a PAP is done).

If no PAP is done it would still be considered a preventative exam, you would just use the V72.31 diagnosis.


----------



## dr.moersch.office@gmail.com (Jul 20, 2014)

this was taken directly out of a BCBS coding for healthcare reform page.  Maybe this can help

Well Woman Preventative
 Females only beginning at age 10
Effective 8/1/12
CPT codes 99393-99397, G0439, S0612, or S0613 with diagnosis V70.0 or V72.31 – limited to 2 per calendar year
Effective 8/1/12 – 7/31/13
CPT codes 99383-99387, G0438, or S0610 with diagnosis V70.0 or V72.31 – limited to 1 per calendar year
Effective 8/1/13
CPT codes 99383-99387, G0438, or S0610 with diagnosis V70.0 – limited to 1 per calendar year
CPT codes 99383-99387, G0438, or S0610 with diagnosis V72.31 – limited to 1 per calendar year
Preconception
 Females only beginning at age 10
same procedure codes as above


----------



## mitchellde (Jul 20, 2014)

V72.31 excludes V76.2 per the ICD-9 CM convention in the code book and cannot be coded together.


----------



## Thath041 (Jun 3, 2015)

Yes it should be V76.47 with pap per  * use additional code notes (not V76.2)


----------



## mitchellde (Jun 3, 2015)

That is only if a vaginal pap is performed and not the cervical pap.  A vaginal pap is usually performed on a patient that no longer has a cervix.


----------

