Results 1 to 6 of 6

breast exam

  1. #1
    Default breast exam
    Medical Coding Books
    Is a routine breast exam part of an office visit? The situation that came up was a pt came in for a diabetic follow up then mentioned to the provider that she felt a lump in her breast. The provider then did the breast exam on the pt.Is there a seperate cpt code for this or would it be part of the visit?
    Any info would be greatly appreciated!!

    Teresa A. Carrasco, CPC:

  2. #2
    Kansas City, MO
    There is no separate CPT code for a Breast Exam. However, the provider would use the additional history, breast exam and any additional medical decision making to determine which level of E/M he is going to bill.

    Now, there is a HCPCS code S0613 Annual gynecological examination; clinical breast examination without pelvic examination. Not all carriers recognize or even use this code.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  3. #3
    If the patient felt a lump in the breast then it is likely not a routine breast exam. This needs to be documented and considered for the level of E/M as Angela already mentioned. Also make sure to include the proper ICD-9 code on your claim.
    Karolina, CPC, CPMA, CEMC

  4. #4
    Tucson Cactus Coders
    In this case I would include this as part of the office visit. Use dx code V76.10 for the breast exam.

    If the provider completed a gyn exam, then in that case you can bill a preventive plus exam.

  5. Default
    I agree it is inclusive with the office visit. I would code it as a breast mass/lump. I would not use V76.10.

  6. #6
    Thanks for all the info!!! ;0)
    Teresa A. Carrasco, CPC:

Similar Threads

  1. annual exam w breast exam only
    By OBcoder2017 in forum OB/GYN
    Replies: 1
    Last Post: 04-11-2014, 05:09 PM
  2. Replies: 8
    Last Post: 12-09-2011, 02:30 PM
  3. Breast Exam
    By pglazener in forum Medicare Regulations
    Replies: 2
    Last Post: 03-30-2011, 11:08 AM
  4. Breast exam
    By jouanlychen in forum Internal Medicine
    Replies: 5
    Last Post: 01-17-2011, 11:51 AM
  5. Breast Exam Only
    By heatherwinters in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-15-2007, 06:15 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.