# Woman's physical vs. Well Woman Exam



## fredcpc (Dec 23, 2010)

This is a re-visit of a confusing scenario. We have an Internal med doctor that saw a female for an "Annual Assessment." The patient is 61, and non-Medicare. The patient has various chronic, but stable problems; and one new insignificant problem, Ear Dermatitis. 

As a part of her Annual, she had pelvic/breast exam and a pap smear. She also had a Blood Occult test, 82270, but it is not documented of when and where the card were given out. I think it is new patient exam. The notes read like a physical with a 

CPT: 99386; but what is the diagnosis? 

What is the difference between a woman's annual physical and a well woman exam?


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## Lisa Bledsoe (Dec 27, 2010)

Preventive exams are age/gender appropriate; so when a woman has this type of encounter that includes the pap and pelvic/breast exam, it should be coded V72.31 and V76.2.  She is only new if she has not been seen by any other IM provider in your practice within the last 3 years.

Do not bill for the stool kit until it is returned to your office for completion of the test.


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## mitchellde (Dec 27, 2010)

Lisa Curtis said:


> Preventive exams are age/gender appropriate; so when a woman has this type of encounter that includes the pap and pelvic/breast exam, it should be coded V72.31 and V76.2.  She is only new if she has not been seen by any other IM provider in your practice within the last 3 years.
> 
> Do not bill for the stool kit until it is returned to your office for completion of the test.



You do not code the V76.2 when you code a V72.31 .  Look at the note with the V72.31 it excludes the use of the V76.2.  However if a Vaginal pap was performed due to absence of cervix then you do add a V76.47  with the appropriate V88.0x code.


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## mitchellde (Dec 27, 2010)

As far as what is the difference between a well woman physical and a well woman exam... to me they are just two ways of saying the same thing.  It is a preventive encounter either way.


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## Lisa Bledsoe (Dec 27, 2010)

mitchellde said:


> You do not code the V76.2 when you code a V72.31 .  Look at the note with the V72.31 it excludes the use of the V76.2.  However if a Vaginal pap was performed due to absence of cervix then you do add a V76.47  with the appropriate V88.0x code.



I stand corrected on V76.2.  It should be V72.31 and V76.47 (with or without the appropriate V88.0X) as Debra states.


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## btadlock1 (Dec 27, 2010)

Okay, ladies - now here's _my_ question on this issue - Since there are no specific "elements" for a routine E/M's history and exam (as there are for problem oriented), how do you know what information in the note should be credited to the routine exam, and what can be credited to the problem-oriented portion, so that the correct problem E/M can be selected? Or does it even matter? For example, with fredcpc's patient, what elements of the history and exam would be considered part of the routine exam, and what could be counted as ROS/ PFSH / Phys. Exam elements for the problem E/M code selection? Or would you select the problem E/M based solely off of the MDM? I don't know where to draw the line, and it's not a topic I've been able to find much information on...

Thanks!


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## fredcpc (Dec 27, 2010)

*Woman's Physical v. Well Woman*

Thank you. So this 61-year old, non-Medicare patient still has her cervix, so I am coding just a V72.31. The V76.46 and V88.0x is for a Pap w/o a cervix. Debra or Lisa, I am correct with this?

Also, the Rectal part of the exam states, "Reveals Hemocult negative stool." So it this means that the stool kit was returned and they have the results. So I am correct with 82270?

Lastly, the patient has Fibromyalgia, and the doctor just be more compliant with your meds. Ear Dermatitis of which the doc Rx'd Prednisolone. And, Depression, doc said to continue with current meds. I would say all insignificant and "Not" worth a separate E&M code. Feedback??

So I have a 99396 or 99386 linked to only V72.31
And 82270 linked to V76.51.
Add Dxs for Fibromyalgia and Ear Dermatitis. Total of 4 codes. Then, life is good. How am I doing here?


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## Lisa Bledsoe (Dec 27, 2010)

fredcpc said:


> Thank you. So this 61-year old, non-Medicare patient still has her cervix, so I am coding just a V72.31. The V76.46 and V88.0x is for a Pap w/o a cervix. Debra or Lisa, I am correct with this?
> 
> Also, the Rectal part of the exam states, "Reveals Hemocult negative stool." So it this means that the stool kit was returned and they have the results. So I am correct with 82270?
> 
> ...




It is my understanding that a single guiac card at the time of service is not separately billable, and that 82270 and 82274 are the kits that patients take home and return.

As for determining whether or not you have a separately reportable E/M, I would reference you to the Preventive Medicine Services section in CPT (pg 31-32 in the Professional edition for 2010).  This section describes what is and is not a separately identifiable problem oriented E/M.  My interpretation of this is that the problem should be either new, or if chronic it must require more work-up and treatment than the patient's usual chronic issues (for example uncontrolled diabetes addressed at the same encounter as the PE vs controlled diabetes addressed at the same encounter as the PE).


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## fredcpc (Dec 27, 2010)

*Woman's Physical v. Well Woman*

THank you lisa. Do you agree with my Well Woman dx codes? Just a V72.31. 

And, she did have a new problem, Ear Dermatitis, and the doctor gave out a Rx for it. I think it is insignificant, but others may add a 99212-25.


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## mitchellde (Dec 27, 2010)

fredcpc said:


> Thank you. So this 61-year old, non-Medicare patient still has her cervix, so I am coding just a V72.31. The V76.46 and V88.0x is for a Pap w/o a cervix. Debra or Lisa, I am correct with this?
> 
> Also, the Rectal part of the exam states, "Reveals Hemocult negative stool." So it this means that the stool kit was returned and they have the results. So I am correct with 82270?
> 
> ...



Stellar!  You are correct in that if there is a cervix you use only the V72.31 I also agree with no 99212 in this instance.


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## fredcpc (Dec 27, 2010)

*Woman's Physical v. Well Woman*

Thank you Debra, Lisa and Brandi. I really appreciate you expertise.


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