Pediatric Coding Alert
Pelvic Examinations
Question: We're not sure how to bill for pelvic exams. Sometimes contraception is also prescribed, and a Pap smear is performed. What do you recommend for the CPT code and the diagnosis code?
Ohio Subscriber
Answer: There is no CPT code for a pelvic exam. It's usually performed with a well visit. Code the well visit (99384-99385, new patient; 99394-99395, established patient) linked to routine infant or child health check (V20.2). Or, if the child comes in specifically for birth control, report the patient office-visit (99201-99205, new patient; 99211-99215, established patient) with general counseling and advice (V25.0x). If the pelvic is done because of a medical problem, such as pain, bill 99201-99215 with a diagnosis of pain (789.xx). Do not bill for the Pap smear separately because it is included in the visit.
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