# Medicare & GYN Visit



## kimlee (Jul 24, 2010)

Medicare is supposed to pay a pelvic exam (w/ all the rules) w/ CPT G0101.  I have a large amount of patients who qualified for their exam and were billed w/ G0101 and V72.31.  They have not paid a single one for 2009 & 2010.

Anyone else have this problem?


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## janie (Jul 25, 2010)

*Janie Elliott CPC CEMC*

We are a Rural Health Clinics and WPS has a problem within their software.  It was opened as an ME issue on Thursday, so hopefully they will get it fixed.  

Thanks Janie


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## erin06578 (Jul 25, 2010)

hi i work in a gyn office we dont use the v72.31 code with medicare patients we use the v76.1 code i hope this helps


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## Lisa Bledsoe (Jul 26, 2010)

kimlee said:


> Medicare is supposed to pay a pelvic exam (w/ all the rules) w/ CPT G0101.  I have a large amount of patients who qualified for their exam and were billed w/ G0101 and V72.31.  They have not paid a single one for 2009 & 2010.
> 
> Anyone else have this problem?



Are you sure it has been 2 years since their last breast and pelvic?  You certainly have the right code combination.


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## kellitilbury (Aug 7, 2010)

I have only been billing paps for our lab for less than 6 months but I have been told to use V76.2 and V72.60 with the G0101 with medicare pts


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## mitchellde (Aug 7, 2010)

V76.1 is for a breast exam only, G0101 is cervical or vaginal and is for a breast and pelvic exam.  So you need the V72.31 which includes the V76.1 and the V76.2.  HOWEVER if the patent has no cervix due to a total hyst or other reason then you add a V76.47 and a V88.01-03 codes.  A V76.2 is for cervical pap which may not be applicable for a particular patient.  We must examine the documentation to tsee which is applicable.


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