Wiki V70.0 vrs. V72.31, please help!

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Karyzmagirl

Karyzmagirl

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I code for multiple Family Practice offices and there is an on going discussion, whether it is appropriate to code a Physical Exam done with a pap and pelvic, breast done with the V70.0 or the V72.31. The problem is that the documentation states patient is here for the annual physical exam. That would direct me to use the V70.0 but they are doing the pap and pelvic, breast so should this be coded as the V72.31. I have queried some of my co-workers and they are coding this scenario with the V70.0 primary and the V72.31 secondary...this just does not seem right to me?????

Thank you for any input you have:confused:
 
I have done billing for both Gyn and internal med. Whenever a patient came in for her yearly, I would code as V72.31 IF she is getting pelvic exam ( without of without a pap smear)
Thats my opinion , for what it is worth :D

Good luck!
 
I would use both if a preventive visit is being preformed and billed in addition to the pelvic exam otherwise if it just the pelvic and you are billing a new or established visit I would only use the v72.31
 
I would use the v70.0 for the annual and the v72.31 if the pap was done and it wasn't an expected part of the annual. Also, I know there is a hospital code for manual breast exam (89.36) but i have used v76.19 for a breast exam in pcp. someone please correct me if that is wrong!! I use that for SNF too.
 
v72.31 VS v70.0

If the physical includes pelvic and pap we code V72.31. If physical is done w/out pelvic and pap we code V70.0, but we never use both V70.0 and V72.31 together it's either one or the other. Hope this helps

L.Nagai, CPC
 
lnagai said:
If the physical includes pelvic and pap we code V72.31. If physical is done w/out pelvic and pap we code V70.0, but we never use both V70.0 and V72.31 together it's either one or the other. Hope this helps

L.Nagai, CPC
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We code this way also, we never use both but one of my colleague disagrees, she codes V70.0 with V72.31. What is your reasoning on why you code this way? Maybe coming from an outside source will help my colleague understand. Thanks!
 
I code with the V70.0 and V72.31 codes very often. V70.0 would be used for annual exams, and V72.31 would be for a pap smear/gynecological exam. I work in a doctors office in Scottsdale, Arizona. Hope this helps!! :)
 
jifnif said:
I would use the v70.0 for the annual and the v72.31 if the pap was done and it wasn't an expected part of the annual. Also, I know there is a hospital code for manual breast exam (89.36) but i have used v76.19 for a breast exam in pcp. someone please correct me if that is wrong!! I use that for SNF too.
Click to expand...

the 89.36 is a volume 3 procedure code for inpatient facility use only, V76.19 is the diagnosis code used in all settings for a breast screening.
 
You do not use V70.0 and V72.31 together. There is a Coding Clinic guidance around this (I have heard). If the visit is for the patient's annual exam and the GYN is not performed, you use V70.0. If the annual exam includes the GYN component, you use V72.31.
 
Where can someone find and print official billing guidelines online? Example: Physician wants to know the exact billing guidelines regarding v70.0 vs v72.31.
 
V70.0 & v72.31

Please advise I code for several Family Practice offices and the physicians want us to bill a well visit with a gynecological exam. There is an on going discussion, on whether it is appropriate to code a Physical Exam and the well woman on the same date of service. I would like to be able to refer to billing guidelines so if anyone could please tell me if there is a website or link I would greatly appreciate it.
 
Per principal first listed DX for V codes in the ICD-9 guidelines V70.0 can only be first listed . So if the gynecological component is done. V72.31 would replace the V70.0
 
lnagai said:
If the physical includes pelvic and pap we code V72.31. If physical is done w/out pelvic and pap we code V70.0, but we never use both V70.0 and V72.31 together it's either one or the other. Hope this helps

L.Nagai, CPC
Click to expand...

You are correct, The ICD-9 guidelines for VCodes that may only be principal/first listed diagnoses goes over this . V70.0 is a first listed only , so if the gynecological component was done it would replace the V70.0 w/ V72.31
 
I work for Family Practice and Internal Meds providers and we bill using both the V70.0 and the V72.31 as the secondary. This is because a V72.31 is not as comprehensive as an annual PE (V70.0). And the V70.0 does not include the Pap Smear, Breast Exam and Pelvic Exam.

The principal/first listed diagnosis codes list does not include the V72.31 therefore billing the V70.0 as the primary and V72.31 is still acceptable.

Our office uses the AMA 2015 Professiona Edition for Physicianx ICD 9-CM and under I.C.18.e has a list of diagnosis codes that fall under the principal/first diagnosis.

Hope this helps.
 
There is an excludes note at V72 "Excludes: general medical examination (V70.0-70.4)."
An excludes note under a code indicates that the terms excluded from the code are to be coded elsewhere. This leaves open the possibility of reporting both codes though it is probably unnecessary since a general medical examination for a woman typically includes the gynecologic exam except when she chooses to see two different physicians for the services or when billing Medicare or other plans that limit coverage of the annual physical.
 
Put simply V70.0 is annual exam. V72.31 is NOT annual exam WITH Gyno. Its just Gyno. So you have to use both.
 
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