Cpx/breast Exam Help!

MsMaddy

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Today I was in the meeting with my Doctors and a question came up.
One of the Doctor asked, when pt comes in for cpx only V70.0 does breast
exam fall under that code? Or does breast exam fall under dx V72.31 the gyn exam?


Thank You All

MsMaddy
 

smwermter

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I have wondered about this as well. I just want to make sure I am understanding correctly... So, even if no pelvic exam at all is performed but a breast exam is we can still use the V72.31 instead of V70.0? I knew there didn't need to be a pap smear performed with the V72.31, but I was under the understanding that a pelvic exam had to be??? :confused:
Thanks in advance for the help! :)
 

dmaec

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I use V70.0 for the px -
V76.19 for the breast
V76.2 for the pap
however, reading the V72.31 - it does state gynecological exam with or without pap. So maybe I could just be using the V72.31.

haven't had any denials with the codes I'm using though. But maybe I don't need them all...hmmm?:confused:
{that's my opinion on the posted matter}
 

MsMaddy

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Yes, You can use V72.31 if the doctor only does phisycal and gyn exam without collecting a smear(pap smear). Any time doctor looks into the vagina and the cervix is considered gyn exam with out smear, so you can use V72.31.


MsMaddy
 

MsMaddy

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The breast exam falls under V72.31-
I thought the same and responded to my doctors that breast exam does fall
under V72.31, Some doctors we not sure about that and told them I"ll look into it
and let them know. Can you give me more info on that.

Thank You Very Much!

MsMaddy
 

smwermter

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If a patient comes in for physical exam and no pelvic or pap is done but a breast exam is performed I code this V70.0 and V76.19. If a patient comes in for the same physical exam but a pelvic is performed I use V72.31. Is this how others are doing it?

(Donna I notice you are in Duluth...I am in Brainerd! Small world!:) )
 

debi7478

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So when a pt comes in for Just for her Well Women exam (not Medicare) are you using 9921X and V72.31, V76.2 or G0101 and Q0091 and how are being reimbursed? We have this controversy because we will do the CPE 9938X and pt may go to another one of our docs for her Pap then what?? :rolleyes:
I am finding most ins will only pay for 1 preventive CPT code per 365 days and if we break it down in 2 visits they have exceeded their limit.??????
 

abyrne

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So when a pt comes in for Just for her Well Women exam (not Medicare) are you using 9921X and V72.31, V76.2 or G0101 and Q0091 and how are being reimbursed? We have this controversy because we will do the CPE 9938X and pt may go to another one of our docs for her Pap then what?? :rolleyes:
I am finding most ins will only pay for 1 preventive CPT code per 365 days and if we break it down in 2 visits they have exceeded their limit.??????[/QUOTE]


If the patient comes in just for the pap and pelvic, and does not have the full physical exam,you would bill an office visit with Dx V72.31. G0101 and Q0091 should only be used if the patient has medicare.

If the patient is seen for their CPE and the preventive code is billed, then they return to have their pap done, you would bill an office visit level for the pap.

Hope this helps.
Alaina:)
 

Lisa Bledsoe

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So when a pt comes in for Just for her Well Women exam (not Medicare) are you using 9921X and V72.31, V76.2 or G0101 and Q0091 and how are being reimbursed? We have this controversy because we will do the CPE 9938X and pt may go to another one of our docs for her Pap then what?? :rolleyes:
I am finding most ins will only pay for 1 preventive CPT code per 365 days and if we break it down in 2 visits they have exceeded their limit.??????
True - most insurance carriers will only pay one per year regardless of V70.0 and V72.31. Also, as far as I know, only Medicare recognizes the G and Q codes...
 

MsMaddy

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Alaina is %100 correct. That is how we do it in our family practice. We have pt that come in for cpx/pap but we find out they are on period, then we only do cpx with prevenative and dx V70.0. Then they come back on a different date for pap only and we do office level only and use dx V76.2 pap only.

Hope this helped

MsMaddy
 
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