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Thread: preventative and non medicare gyn

  1. #1
    Join Date
    Apr 2007

    Default preventative and non medicare gyn

    AAPC: Back to School
    What is the correct way to code a non medicare patient who comes in for a complete annual physical along with a complete annual gyn? Would it be for an established patient ex. 99396 with S0612 with dxs v70.0 and v72.31 & V76.47 attached to the appropriate CPTs? Confused!

  2. #2
    Join Date
    Apr 2007

    Default Preventative Medicine

    This link has a great article on Preventative Medicine Coding


    THE STANDARD PREVENTIVE E/M SERVICE: AN EXAMPLE A 28-year-old established patient comes to your office for her well-woman examination. You take the patient's interval medical, family and social history and perform a complete review of systems. You also perform a physical examination that includes a blood-pressure check and thyroid, breast, abdominal and pelvic examinations, and you obtain a Pap smear. The patient is on oral contraceptives and has concerns about intermittent break-through bleeding. You counsel the patient regarding alternatives and give her a prescription for a new medication. You also counsel the patient about diet, exercise, substance abuse and sexual activity. Then you send the Pap smear to an outside laboratory that will bill the test directly to the payer. Although the patient has concerns about her current method of birth control, the associated counseling and change in medication is considered part of the preventive medicine service for her age group, so you should submit 99395, "Periodic comprehensive preventive medicine ..., established patient; 18-39 years," and ICD-9 code V72.3, "Gynecological examination."
    Bill Diagnosis code(s) Procedure code(s) Patient V72.3 Gynecological examination 99395 Preventive service

  3. #3
    Join Date
    Apr 2007

    Default Still alittle fuzzy

    Thank you, but I'm still a bit perplexed on the usage of HCPCs codes S0610 Annual gyenocological exam, new patient adn S0612 Annual gyn exam established patient and S0613 Annual gyn exam clinical breast exam without pelvic exam. Are these used with the preventative as the medicare g0101 and Q0091?

  4. #4
    Join Date
    Apr 2007

    Default Exams


    Annual gynecological examinations and routine pap smears
    Payment will be made for one annual gynecological examination (G0101, S0610 or S0612) regardless of the
    patient’s condition, and one routine Pap smear (G0123-G0145, G0141-G0148, P3000, P3001) per calendar
    year for all females.

    A gynecological exam (code G0101, S0610 or S0612) may include, but is not limited to, these services:
    history, blood pressure and/or weight checks, physical examination of pelvis, genitalia, rectum, thyroid,
    breasts, axillae, abdomen, lymph nodes, heart and lungs.

    When a physician performs a systemic physical examination that includes an annual gynecological
    examination, a medically-focused condition may be encountered. In some instances, treatment for a
    medically-focused condition may require more extensive medical evaluation, treatment and management. This
    treatment may result in significant additional work requiring the key components associated with a
    problem-oriented evaluation and management (E/M) service. In those cases, the appropriate medical (E/M)
    codes (99201-99215, 99381-99397) may be reported in addition to the annual gynecological examination
    (code G0101, S0610 or S0612).

  5. #5
    Join Date
    Apr 2007


    Thank you for your help Heather!

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