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Thread: GYN routine visit ROS requirements

  1. #1
    Join Date
    Apr 2007

    Default GYN routine visit ROS requirements

    AAPC: Back to School
    I am having a hard time finding the EXACT requirements for a routine GYN preventive medicine visit. All that I can find are references to an age and gender specific history, but I am trying to assist with the implementation of a "smart tool" that includes specifically what would be necessary for that type of visit..... I have tried contacting the AMA and the ACOG, but no responses.... are there any OBGYN coders out there who might be able to help me find this information?

    Many Thanks!

  2. #2


    Here's my answer to my OBGYN office just last week:

    What is the difference between a health maintenance exam and a well-female exam?

    A health maintenance exam is a complete physical, including health history, a review of all health and lifestyle risk factors, an exam of all systems including cardiovascular, respiratory, neurological, musculoskeletal, reproductive and behavioral, laboratory studies appropriate for age, risk and sex, and discussion of recommended lifestyle changes. These exams are recommended every five years from ages 18-39, every 2-3 years from ages 40-49, and every 1-2 years for ages 50 and over.

    Well-female exams are far less extensive. You take the patient's interval medical, family and social history and perform a complete review of systems. Your exam is typically limited essentially to pelvic and Pap tests, as well as a blood-pressure check and thyroid, breast, abdominal and pelvic examinations. Ordering of ancillary screening services is also warrented. Well-female exams can be performed by a primary care provider or selected OB/GYN provider.

    The American Academy of Family Practitioners offers valuable information. Below is the webaddy where I some of the information above.


    Wellmark BCBS offered the remainder of the majority of the difference in the exams.

    Hope this helps!

  3. #3
    Join Date
    Apr 2007
    Milwaukee, WI


    There is a certain amount of things that need to be examined if the patient is a Medicare patient, if using the G code. Check out the CMS website to find the check list when billing a G0101.

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