Wiki Preventative exams/pap/WWE

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sgormsen

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My physicians are following the guidelines in which a Pap is done every two years. Here's my delima. If a pap/pelvic exam is not done and just a breast exam, then it's my interpretation that this is just an Office visit 99213- 99215 and not the preventative E & M codes. My docs say that they can bill for example a 99395 with V76.2 & V72.31 because they are following these guidelines even though in the chart note under "genitalia" it says "Not Needed". If they are doing the pap/pelvic exam every 2 years then they should only be billing the preventative exam codes every two years. If I'm correct and I think I am, where can I find documentation to present to my Docs? Any help would be greatly appreciated.
thanks,
susan G
 
There is no requirement of any particular exam elements for 99381-99397, so I agree with your doctor.

These are age/gender based, so whatever the provider feels is appropriate pretty much goes.

Laura, CPC, CPMA, CEMC
 
Ok, so my next concern is that the provider is wanting to use dx codes V76.2/routine cervical pap smear and V72.31/gyn exam, with or without pap, but the definition also includes the verbage "pelvic exam" in which they are not doing. They are only doing a breast exam per the chart note. Under "genatalia" they either write "deferred" or "not done". What are your thoughts? I'm under the impression that if a breast exam is done only then it falls under 99212 - 99215 E & M?

thank you
 
I wouldn't use those dx, I woudl go with V70.0.

As far as the breast exam goes, what is the problem? If there is no problem, just a screening visit, you can't use problem ov codes 99212-99215.

Laura, CPC, CPMA, CEMC
 
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