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Wiki breast exam

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TCarrasco

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Is a routine breast exam part of an office visit? The situation that came up was a pt came in for a diabetic follow up then mentioned to the provider that she felt a lump in her breast. The provider then did the breast exam on the pt.Is there a seperate cpt code for this or would it be part of the visit?
Any info would be greatly appreciated!!:confused:

Thanks!
 
There is no separate CPT code for a Breast Exam. However, the provider would use the additional history, breast exam and any additional medical decision making to determine which level of E/M he is going to bill.

Now, there is a HCPCS code S0613 Annual gynecological examination; clinical breast examination without pelvic examination. Not all carriers recognize or even use this code.
 
If the patient felt a lump in the breast then it is likely not a routine breast exam. This needs to be documented and considered for the level of E/M as Angela already mentioned. Also make sure to include the proper ICD-9 code on your claim.
 
In this case I would include this as part of the office visit. Use dx code V76.10 for the breast exam.

If the provider completed a gyn exam, then in that case you can bill a preventive plus exam.
 
I agree it is inclusive with the office visit. I would code it as a breast mass/lump. I would not use V76.10.
 
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