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Wiki Medicare & GYN Visit

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kimlee

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Medicare is supposed to pay a pelvic exam (w/ all the rules) w/ CPT G0101. I have a large amount of patients who qualified for their exam and were billed w/ G0101 and V72.31. They have not paid a single one for 2009 & 2010.

Anyone else have this problem?
 
Janie Elliott CPC CEMC

We are a Rural Health Clinics and WPS has a problem within their software. It was opened as an ME issue on Thursday, so hopefully they will get it fixed.

Thanks Janie
 
hi i work in a gyn office we dont use the v72.31 code with medicare patients we use the v76.1 code i hope this helps
 
kimlee said:
Medicare is supposed to pay a pelvic exam (w/ all the rules) w/ CPT G0101. I have a large amount of patients who qualified for their exam and were billed w/ G0101 and V72.31. They have not paid a single one for 2009 & 2010.

Anyone else have this problem?
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Are you sure it has been 2 years since their last breast and pelvic? You certainly have the right code combination.
 
I have only been billing paps for our lab for less than 6 months but I have been told to use V76.2 and V72.60 with the G0101 with medicare pts
 
V76.1 is for a breast exam only, G0101 is cervical or vaginal and is for a breast and pelvic exam. So you need the V72.31 which includes the V76.1 and the V76.2. HOWEVER if the patent has no cervix due to a total hyst or other reason then you add a V76.47 and a V88.01-03 codes. A V76.2 is for cervical pap which may not be applicable for a particular patient. We must examine the documentation to tsee which is applicable.
 
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