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Ob-Gyn Coding Alert

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Medicare Rules Differ for Annual Exam

Published on Sat Jan 01, 2005

Question: Should I use V72.31, V76.47 and then V45.77 when a patient comes in to have a Pap during her annual preventive exam?

South Carolina Subscriber

Answer: If she is not a Medicare patient and if she is missing her cervix for a nonmalignant reason, you would code V72.31 (Routine gynecological examination), V76.47 (Special screening for malignant neoplasms; vagina), and V45.77 (Acquired absence of genital organs) under ICD-9 coding rules.
 
Medicare is different. They will only accept V76.2 (Special screening for malignant neoplasms; cervix), V76.47, or V76.49 (Special screening for malignant neoplasms; other sites) with the part of the exam that they cover every two years for a low-risk patient, and only V15.89 (Other specified personal history presenting hazards to health; other) for the yearly exam for a high-risk patient.
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