Wiki Billing Prevenative Well Woman exam

[sgormsen]

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

 

[rmelissa]

I suppose, as in all things, this may vary from carrier to carrier. But I chose CMS. I hope this links help your argument.

http://www.cms.gov/PrevntionGenInfo/

Notice that the breast exam alone, is not even mentioned. Mammography is, Screening Pap Test and Pelvic Examination is mentioned, but not a normal brest exam.

CPC-A

 

[mitchellde]

why would you do just a breast exam and call it a well woman?

 

[Lisa Bledsoe]

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

In my opinion, if they are not performing a breast/pelvic/pap then you have V70.0 with 9939X.