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Well Woman versus Acute Issues

  1. #1
    Default Well Woman versus Acute Issues
    Medical Coding Books
    Hello everyone,

    A question has been asked by an office associate about billing diagnosis code V72.31 when a pap and well woman visit is done and it being denied by Medicare.
    I can see that Medicare would deny a claim using V72.31 if the patient had a pap/well woman exam done within the 2 years prior to that encounter.We should not bill a routine diagnosis code (V72.31) for an encounter that is not a complaint visit or high risk patient which is the only reason I can see that a pap and/or well woman should be done within the two year coverage time frame.
    I am being told by an AR associate that Medicare always denys V72.31 being billed with a well woman exam and/or pap but I do not see how that is possible to happen everytime since patients are allowed a routine well woman and/or pap every two years.
    It seems to me if a patient is coming in for a routine well woman and pap we should be fine to bill G0101 and Q0091 with diagnosis codes V72.31 and V76.2. If the patient is coming in for a well woman and/or pap within the two year coverage time frame because she is high risk or has complaints then we should bill diagnosis codes V76.2 plus any diagnosis codes indicating why she is high risk or what the complaints are.
    Can anyone confirm that for me and tell me your thoughts?


  2. #2
    Default Medicare exam
    If you are billing the G0101 and Q0091 for a patient for routine visit every two years you do use either the V72.31 or V76.2. If they are coming in every year for Gyn exam due to high risk it should be billed with the V15.89 per Medicare guidelines. The CMS Medicare website should list what the deem as a high risk patient.

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