Wiki Difference between V72.31 and V76.2

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hthompson

hthompson

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I have my own understanding of what these two codes mean and how they are used, but I would like some input as to what you all see as their differences and when you would use one over the other since they both exclude each other.

Thanks in advance!
 
What we use

:) We use V7231 for all private insurance and V762 for Medicare on routine Pap Smears. It is really what the insurance co wants.
 
V72.31 includes the V76.2 It is a well woman exam and should also be used for Medicare. However if the patient has had a hysterectomy then you would not use the V76.2 as the patient has no cervix so you would code the V72.31 with the V76..47 and a V88.0x code.
The V72.31 identifies the encounter as a well woman.
 
@mitchellde: That was pretty much what I thought. I code V72.31 for all routine annual well woman exams, unless it was just a physcial with no gyn component, then I use V70.0. If it was a pap for another reason (F/U for abnormal pap, etc) then I use V76.2.

Is this understanding across the board?

I had a talk with my MD about which code to use... so I'm clarifying in my mind what the consensus is and why...

Thanks!
 
Keep in mind that if your doc is performing a well woman exam you have to use the V72.31 with the appropriate preventative code even if the patient is a medicare patient, however, you should be carving out the pap/pelvic exam from this and using V76.2 if the pap is from the cervix or if it is a vaginal pap on a patient who had a hysterectomy for a non malignant condition use V76.47 along with a V88.XX for aquired abscence of uterus, cervix, etc...for the pap or if the hysterectomy was due to a malignant condition use V67.01 for pap, the V88.X for the acquired absence, and the V10.XX for the type of malignancy.

If you aren't familar with doing carve outs....visit ACOG (american college of obstetrics and gynecology) website or CMS that explains exactly how you do it.
 
V72.31 for lab test

I have a question relating to code V72.31. Patient goes to the clinic and has a routine screening. Patient has had a hysterectomy. The clinic billed the claim with V72.31 as they should and for the lab test used code V76.47 and V88.01, which I seen no issue with. However, we an insurance company that says they only have 4 codes that they accept and pay as preventative. V72.31 (which would be the only one that would apply here) V76.2, V70.0, V72.32. They will not accept the V76.47 or V88.01 and pay as preventative. (which on a side note is frustrating). I discussed this with someone at the lab to ask their opinion about using V72.31 on the pap test for the dx but they said that they were under the impression that the V72.31 could be used for the office visit only and additioanl dx were used for the pap. Help here? IS V72.31 acceptable both on the visit and the pap test? If so, what should I discuss further with the ins co?
 
lab is back, but we don't see the results, the MD does. There was nothing abnormal or anything special that they had to do, because lab personal at the clinic would have had us charge in addition to the vaginal screening code....
 
It would not matter the results since it was performed as a screening. The lab would use the screening V code. The office is correct in their choice of codes. If the payer is not covering the Vaginal pap as a replacement for the cervical pap, then you could try to appeal this. But does your contract state anything in regards a vaginal pap for screening? If they only accept the cervical screening code or is it that they did not think it all the through. You cannot code a screening based on the results.
 
I was in the same thought as the office. I just wasnt sure if it made a difference and if we could use the V72.31 on the lab test. This insurance company is the first one that I have personally come across this with. They said that they have 4 codes only that they will pay preventative on and none of the 4 (above stated) applies to that patient. I tried to tell the company personally that this is the way they (the papscreen) was coded. V76.2 wouldnt apply to the patient according to the V88.01 that was on the as the diagnosis intially. I am at a loss what to do and the patient is very upset, as expected. Thanks all for your assistance.
Val, CPC, CEDC
 
perhaps the ins sees no medical necessity if a vaginal pap after a total hyst. If that is the case this is something that should be in your contract and also more importantly in the patient's benefits . It cannot be an arbitrary decision, the patient should have known this, whether they did or not, the point is they should have.
 
For preventative, our clms are submitted with V72.31 for the GYN exam, and V76.2 for the PAP. This seems to work with the payers.

Martha Sims-Green, BS. CPC
 
healthtecsystems said:
For preventative, our clms are submitted with V72.31 for the GYN exam, and V76.2 for the PAP. This seems to work with the payers.

Martha Sims-Green, BS. CPC
Click to expand...

If you look at the post , the issue is the patient has no cervix. also the V72.31 excludes using the V76.2. And the instructions state to add the V76.47. Just because the payer pays something does not mean it was coded correctly. The dx codes must be correct for the patient since it is THEIR diagnosis that you are coding.
 
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