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Well women exam

  1. #1
    Default Well women exam
    Medical Coding Books
    I work for a large family practice group, we have been billing for annual well woman exams using a preventive code in addition to the QOO91. Can someone please give some feed back on how we should be billing this service for commercial insurances and what diagnosis codes we should be using?

  2. #2
    I have this information from AAP , I know its pediatrics but it does mention physicals and paps for women.Hope it helps

    When Performed as Part of a Preventive Medicine Visit

    Preventive medicine visit services (99381–99397) include a comprehensive (age- and gender-appropriate) history and physical examination that are not synonymous with the history or physical examination components in problem-oriented codes. The CPT guidelines stipulate that preventive medicine services provided to patients from ages 12 through 39 years (CPT codes 99384/99394 and 99385/99395) include the pelvic and breast examination and obtaining a Pap smear.

    The Pap Smear

    CPT codes 88141–88154, 88164–88167, 88174, and 88175 are used to report the various methods of Pap smear screening and the physician interpretation. The primary care physician does not report these codes. However, CPT code 99000 (handling or conveyance of specimen for transfer from the physician's office to a laboratory) may be reported in addition to reporting the preventive medicine or problem-oriented visit

    Medicare Requirements

    Medicare requires that Healthcare Common Procedure Coding System code Q0091 (screening Papanicolaou; obtaining, preparing, and conveyance of cervical and vaginal smear to laboratory) be reported separately with the appropriate E/M service. Some Medicaid programs and commercial payers may also recognize code Q0091 as a separate service. If reporting Q0091, it is not appropriate to also report 99000.

  3. #3
    I researched this time and time again. Think I have it done now.

    As far as for PPO insurance, in regards to well women exams.

    I would bill for the Well women and collection for a pap as followed



    I show these steps to my physcians I work for all the time. But like I tell them the Q0091 doesn't always get paid, but it's better than using 99000 because when these get both get paid at different encounters I've seen that the Q0091 always wins out.

    Average payment I've seen using the Q0091 code is from 16.00 to 42.00. Not bad.


  4. Cool Well woman exam coding
    I just started some family practice coding. I have a WWE for a patient with Aetna. I don't want to miss any possible revenue.

    Does this sound right?
    DX: V72.31
    G0101 (is this a Medicare only code?)

    Thanks in advance!!

  5. #5
    G0101 is for Medicare and Medicare advantage plans only. The pap and breast exam components are included in the preventive code. CPT 99000 is not billable. Its bundled.
    Teresa Kelley, CPC
    Detroit, MI AAPC Chapter member

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