# preventative and non medicare gyn



## Eve (May 29, 2008)

What is the correct way to code a non medicare patient who comes in for a complete annual physical along with a complete annual gyn?  Would it be for an established patient ex. 99396 with S0612 with dxs v70.0 and v72.31 & V76.47 attached to the appropriate CPTs?  Confused!


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## heatherwinters (May 30, 2008)

*Preventative Medicine*

This link has a great article on Preventative Medicine Coding

http://www.aafp.org/fpm/20040400/49maki.html

*THE STANDARD PREVENTIVE E/M SERVICE: AN 			 EXAMPLE*  		  		  		    			 A 28-year-old established patient comes to your office for her 				well-woman examination. You take the patient's interval medical, family and 				social history and perform a complete review of systems. You also perform a 				physical examination that includes a blood-pressure check and thyroid, breast, 				abdominal and pelvic examinations, and you obtain a Pap smear. The patient is 				on oral contraceptives and has concerns about intermittent break-through 				bleeding. You counsel the patient regarding alternatives and give her a 				prescription for a new medication. You also counsel the patient about diet, 				exercise, substance abuse and sexual activity. Then you send the Pap smear to 				an outside laboratory that will bill the test directly to the payer. Although 				the patient has concerns about her current method of birth control, the 				associated counseling and change in medication is considered part of the 				preventive medicine service for her age group, so you should submit 99395, 				"Periodic comprehensive preventive medicine ..., established patient; 18-39 				years," and ICD-9 code V72.3, "Gynecological examination."
*Bill* *Diagnosis 							 code(s) * *Procedure 							 code(s) *  						  						  						     						     						     						     						     						  						  						  Patient  						  V72.3  						  Gynecological 							 examination  						  99395  						  Preventive service


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## Eve (May 30, 2008)

*Still alittle fuzzy*

Thank you, but I'm still a bit perplexed on the usage of HCPCs codes S0610 Annual gyenocological exam, new patient adn S0612 Annual gyn exam established patient and S0613 Annual gyn exam clinical breast exam without pelvic exam.  Are these used with the preventative as the medicare g0101 and Q0091?


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## heatherwinters (May 30, 2008)

*Exams*

https://www.highmarkblueshield.com/pdf_file/HighmarkBlueShield-Section15.pdf

Annual gynecological examinations and routine pap smears
Payment will be made for one annual gynecological examination (G0101, S0610 or S0612) regardless of the
patient's condition, and one routine Pap smear (G0123-G0145, G0141-G0148, P3000, P3001) per calendar
year for all females.

A gynecological exam (code G0101, S0610 or S0612) may include, but is not limited to, these services:
history, blood pressure and/or weight checks, physical examination of pelvis, genitalia, rectum, thyroid,
breasts, axillae, abdomen, lymph nodes, heart and lungs.

When a physician performs a systemic physical examination that includes an annual gynecological
examination, a medically-focused condition may be encountered. In some instances, treatment for a
medically-focused condition may require more extensive medical evaluation, treatment and management. This
treatment may result in significant additional work requiring the key components associated with a
problem-oriented evaluation and management (E/M) service. In those cases, the appropriate medical (E/M)
codes (99201-99215, 99381-99397) may be reported in addition to the annual gynecological examination
(code G0101, S0610 or S0612).


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## Eve (May 30, 2008)

Thank you for your help Heather!


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