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Pelvic Exam

  1. #1
    Smile Pelvic Exam
    Medical Coding Books
    In our internal medicine office, we offer women pelvic exam and paps. We bill for pelvic exams. With commercial insurances there has been a question of the pelvic exam code that we are using because that code is generally used with anesthesia. What is the proper code to be used with BCBS of NC, UHC of NC, ect....I need help in this...
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    What codes are you using? If your providers are doing an actual preventive visit including a pap and pelvic, you should be using 9938x-9939x. If you are only doing a pap with a pelvic AND breast exam, most carriers will probably recognize Q0091 and G0101. They do in our area anyway.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default Code for pelvic exam
    We are using in our office 57410 for the commercial carrier. For Medicare, we are using Q0001 and G0101. Is 57410 correct to use for a basic pelvic exam?
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by encomma-watson View Post
    We are using in our office 57410 for the commercial carrier. For Medicare, we are using Q0001 and G0101. Is 57410 correct to use for a basic pelvic exam?
    Absolutely NOT! 57410 is a diagnostic exam performed under general anesthesia. It is not ever to be used for a wellness preventive exam or any pelvic exam performed in the office setting. I am wondering what dx code you are linking to this? For commercial ins that does not recognize the Q and G code you must use the preventive E&M code and if the patient has no benifit fro preventive then they are responsible.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by mitchellde View Post
    Absolutely NOT! 57410 is a diagnostic exam performed under general anesthesia. It is not ever to be used for a wellness preventive exam or any pelvic exam performed in the office setting. I am wondering what dx code you are linking to this? For commercial ins that does not recognize the Q and G code you must use the preventive E&M code and if the patient has no benifit fro preventive then they are responsible.
    Ditto Debra!
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Smile Pelvic exam
    We are using 616.10 and Cervical Cancer Screening diagnosis. Pelvic examinations are done with every pap. I know that with MCR will only pay with the G0101 and Q0061, but commercial insurances does not recognize those codes so what should I do. This is my first time dealing with this. I came from the pediatric world.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
    Default
    616.10 is a diagnosis of vaginitis. This should not be used for a wellness exam. If the patient scheduled a wellness and this is a well woman exam then your dx code is V72.31 you do not code the V76 for cervical screening as it is included but if your patient has had a total hyst and has no cervix then you did a vag pap and you do add that V76.x code for vaginal. I cannot not imagine that your patients are very happy with being given dx of vaginitis and a surgical procedure that they have to meet their deductible with. I guess the first question then is were these scheduled as annual exams. If so and vaginitis is diagnosed as a part of that then the vaginits is a secondary dx code and with some payers you can charge a split encounter meaning a well visit (preventive E&M) and an office visit (99212) with a 25 modifier. But my question is how many of these that have been billed out have vaginitis documented with a pelvic performed under anesthesia? The implications of this kind of billing are hugh and patients are being given a dx that may not be supported in their chart notes but they do not know that. I say stop and go read some chart notes, charge based on the reason for the encounter. If the patient has preventive benefits then great if not they will be responsible.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by encomma-watson View Post
    We are using 616.10 and Cervical Cancer Screening diagnosis. Pelvic examinations are done with every pap. I know that with MCR will only pay with the G0101 and Q0061, but commercial insurances does not recognize those codes so what should I do. This is my first time dealing with this. I came from the pediatric world.
    Elizabeth - we checked with our other insurance plans and most of them do recognize and pay on the G and Q codes. UHC, PHCS, Great West, Cofinity, Cigna, and Aetna all recognize and pay for these codes.
    Lisa Bledsoe, CPC, CPMA

  9. #9
    Question Thanks
    Thank you all for your help in this. In Greensboro, NC it seems that the primary care physician can do a pap if the female does not have a gyn doctor. Most of the females that we see do have vaginitis, because of them being either very sexually active and don't use protection or they are severly diabetic and are not taking very good care of themselves. Our nurse practioners do the paps and in fact I was in a room with one of our providers and they examined, use the speculum, did a rapid BV, Rapid Trichomonis and GC Clymidia. I did code the 87510, 87808 and the GC clymidia is sent out via lab. Medicare pays for a pap per year. I will have to see if Medicaid pays for the q0008 and G0101. I know that they do pay under the crossover, but i did not know if it pays with just Medicaid itself. I will let you ladies know.

    Please let me know if I am billing this correct.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  10. #10
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I understand that they may have vaginitis on exam but if that is not their complaint and they set up for/reested an annual and vaginitis is found as a result then the V72.31 is the primary and the 616.x is secondary and the preventive is still the E&M, either the preventive or the G and Q, but not the 57410.

    Debra A. Mitchell, MSPH, CPC-H

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