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Thread: Cpt 99381-99397

  1. #1
    Join Date
    Apr 2007

    Default Cpt 99381-99397

    AAPC: Back to School
    I'm very familar with CPT codes 99381-99397, which apply to well visits and physicals and well womens.

    But I've come across thes codes.

    S0610-Annual gynecological exam-new pt.

    S0612-Annual gynecological exam-est. pt.

    S0613- Annual gynecological exam, clinical breast exam without pelvic exam.

    Which these are Temporay national HCPCS codes.

    My question is why in the world were these issued out, and does anyone apply them to there daily practice. If so are you getting reimbursed.

    Looking for ways to increase revenue in my practice.



  2. #2
    Join Date
    Apr 2007
    St. Cloud, MN

    Default S0610-s0613

    We do not cover these codes and Minnesota DHS does not allow them either.
    My guess is they were developed to be used for those female patients that come in strickly for their gynecological examination and do not have any other examination completed instead of billing a complete preventive medicine visit.
    My thought is that some payers would not want to pay for 99384 - 99386, or 99394 -99397 on a patient that only had a gyn exam.
    As I see it though, per CPT guidelines:
    The "comprehensive"nature of the Preventive Medicine Services codes 99281-00397 reflects an age and gender appropriate history/exam and is NOT synonymous with the "comprehensive" examination required in Evaluation and Management codes 99201-99350.
    If a provider completes a gyn exam and feels it is age appropriate and does not complete a total head to toe exam, he/she should still be able to bill the preventive medicine CPT code.
    I am sure though that there may be certain payers that will request in this situation the S codes are to be used.

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