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Preventative exams/pap/WWE

  1. #1
    Exclamation Preventative exams/pap/WWE
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    My physicians are following the guidelines in which a Pap is done every two years. Here's my delima. If a pap/pelvic exam is not done and just a breast exam, then it's my interpretation that this is just an Office visit 99213- 99215 and not the preventative E & M codes. My docs say that they can bill for example a 99395 with V76.2 & V72.31 because they are following these guidelines even though in the chart note under "genitalia" it says "Not Needed". If they are doing the pap/pelvic exam every 2 years then they should only be billing the preventative exam codes every two years. If I'm correct and I think I am, where can I find documentation to present to my Docs? Any help would be greatly appreciated.
    susan G

  2. #2
    There is no requirement of any particular exam elements for 99381-99397, so I agree with your doctor.

    These are age/gender based, so whatever the provider feels is appropriate pretty much goes.

    Laura, CPC, CPMA, CEMC

  3. #3
    Ok, so my next concern is that the provider is wanting to use dx codes V76.2/routine cervical pap smear and V72.31/gyn exam, with or without pap, but the definition also includes the verbage "pelvic exam" in which they are not doing. They are only doing a breast exam per the chart note. Under "genatalia" they either write "deferred" or "not done". What are your thoughts? I'm under the impression that if a breast exam is done only then it falls under 99212 - 99215 E & M?

    thank you

  4. #4
    I wouldn't use those dx, I woudl go with V70.0.

    As far as the breast exam goes, what is the problem? If there is no problem, just a screening visit, you can't use problem ov codes 99212-99215.

    Laura, CPC, CPMA, CEMC

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