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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!!

    Thanks!
    Teresa A. Carrasco, CPC:

  2. #2
    Location
    Kansas City, MO
    Posts
    751
    Default
    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
    angela@medicalrevenuesolutions.com

  3. #3
    Default
    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
    Location
    Tucson Cactus Coders
    Posts
    5
    Default
    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.
    Deborah Herreraherreradeb1@gmail.com

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

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