# Medicare Well woman diagnosis confusion



## jdibble (May 1, 2012)

Good afternoon all!  I am currently new to OB/GYN and am working auditing notes for Medicare well woman visits.  I am confused on the diagnosis codes and cpt codes and was hoping someone could help me! 

I think I understand that if the patient comes in for a pelvic and breast exam I would code G0101.  If they have a PAP I can also code Q0091.  In this case the dx would be V76.2 or V72.31?  Now, I have a patient who came if for her well woman exam, the doctor did a complete exam, including a complete Pelvic exam, however did not do a PAP.  He is billing th G0101 and dx V76.2.  Isn't V76.2 the diagnosis for when a PAP is done? Should he be using V72.31 instead - which says with or without pap? Also, should he be billing an exam code too - 99397?  Or he doesn't need to?

If someone could help me with the correct process of coding these visits for all scenarios I would be greatful - I have to go back to these doctors and tell them if the coded these visits correctly and tell them the correct way and I have myself too confused to at this point to do that! 

Thanks,


----------



## jdibble (May 2, 2012)

Anyone have an idea on this?


----------



## roeslerje (May 2, 2012)

In our office, a well-woman with a Pap is billed G0101 & Q0091 with dx of V72.31.  If a breast/pelvic exam is done without a Pap, we just bill the G0101 with the same dx, V72.31.


----------



## mitchellde (May 2, 2012)

The V76.2 is excluded by the V72.31 so you do not use both codes, If the patient has has a total hyst then there is no cervix for a PAP but the physician may do a vaginal PAP in which case you do use the V76.47 with the V76.41 plus the appropriate V88.xx for the absence of the uterus, if the patient has has a hyst but has a remaining cervical stump which the provided did PAP then you use the V72.31 with the V88.xx code for the absences of the uterus with a remaining cervical stump.


----------



## jdibble (May 3, 2012)

mitchellde said:


> The V76.2 is excluded by the V72.31 so you do not use both codes, If the patient has has a total hyst then there is no cervix for a PAP but the physician may do a vaginal PAP in which case you do use the V76.47 with the V76.41 plus the appropriate V88.xx for the absence of the uterus, if the patient has has a hyst but has a remaining cervical stump which the provided did PAP then you use the V72.31 with the V88.xx code for the absences of the uterus with a remaining cervical stump.



Thanks Debra and Rey for your responses!

@ Debra - I understand what you are saying, but have another question.  If a patient only came in for a PAP, would you use the V76.2 then?  Also, if the doctor does a complete well visit exam on the Medicare patient, should he be billing for that - 99397?  Is an ABN required for these well woman visits and do we need to bill with a modifier?

Thanks for your help!


----------

