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Medicare Well woman diagnosis confusion

jdibble

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Daytona Beach, FL
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Good afternoon all! I am currently new to OB/GYN and am working auditing notes for Medicare well woman visits. I am confused on the diagnosis codes and cpt codes and was hoping someone could help me! :D

I think I understand that if the patient comes in for a pelvic and breast exam I would code G0101. If they have a PAP I can also code Q0091. In this case the dx would be V76.2 or V72.31? Now, I have a patient who came if for her well woman exam, the doctor did a complete exam, including a complete Pelvic exam, however did not do a PAP. He is billing th G0101 and dx V76.2. Isn't V76.2 the diagnosis for when a PAP is done? Should he be using V72.31 instead - which says with or without pap? Also, should he be billing an exam code too - 99397? Or he doesn't need to?

If someone could help me with the correct process of coding these visits for all scenarios I would be greatful - I have to go back to these doctors and tell them if the coded these visits correctly and tell them the correct way and I have myself too confused to at this point to do that! :eek:

Thanks,
 
Last edited:

roeslerje

Networker
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Oklahoma City, OK
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In our office, a well-woman with a Pap is billed G0101 & Q0091 with dx of V72.31. If a breast/pelvic exam is done without a Pap, we just bill the G0101 with the same dx, V72.31.
 

mitchellde

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The V76.2 is excluded by the V72.31 so you do not use both codes, If the patient has has a total hyst then there is no cervix for a PAP but the physician may do a vaginal PAP in which case you do use the V76.47 with the V76.41 plus the appropriate V88.xx for the absence of the uterus, if the patient has has a hyst but has a remaining cervical stump which the provided did PAP then you use the V72.31 with the V88.xx code for the absences of the uterus with a remaining cervical stump.
 

jdibble

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Daytona Beach, FL
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The V76.2 is excluded by the V72.31 so you do not use both codes, If the patient has has a total hyst then there is no cervix for a PAP but the physician may do a vaginal PAP in which case you do use the V76.47 with the V76.41 plus the appropriate V88.xx for the absence of the uterus, if the patient has has a hyst but has a remaining cervical stump which the provided did PAP then you use the V72.31 with the V88.xx code for the absences of the uterus with a remaining cervical stump.
Thanks Debra and Rey for your responses!

@ Debra - I understand what you are saying, but have another question. If a patient only came in for a PAP, would you use the V76.2 then? Also, if the doctor does a complete well visit exam on the Medicare patient, should he be billing for that - 99397? Is an ABN required for these well woman visits and do we need to bill with a modifier?

Thanks for your help!
 
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