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Cpx/breast Exam Help!

  1. Red face Cpx/breast Exam Help!
    Medical Coding Books
    Today I was in the meeting with my Doctors and a question came up.
    One of the Doctor asked, when pt comes in for cpx only V70.0 does breast
    exam fall under that code? Or does breast exam fall under dx V72.31 the gyn exam?


    Thank You All

    MsMaddy

  2. Default
    The breast exam falls under V72.31-

  3. #3
    Default
    I have wondered about this as well. I just want to make sure I am understanding correctly... So, even if no pelvic exam at all is performed but a breast exam is we can still use the V72.31 instead of V70.0? I knew there didn't need to be a pap smear performed with the V72.31, but I was under the understanding that a pelvic exam had to be???
    Thanks in advance for the help!

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I use V70.0 for the px -
    V76.19 for the breast
    V76.2 for the pap
    however, reading the V72.31 - it does state gynecological exam with or without pap. So maybe I could just be using the V72.31.

    haven't had any denials with the codes I'm using though. But maybe I don't need them all...hmmm?
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. Smile
    Yes, You can use V72.31 if the doctor only does phisycal and gyn exam without collecting a smear(pap smear). Any time doctor looks into the vagina and the cervix is considered gyn exam with out smear, so you can use V72.31.


    MsMaddy

  6. Default
    Quote Originally Posted by lavanyamohan View Post
    The breast exam falls under V72.31-
    I thought the same and responded to my doctors that breast exam does fall
    under V72.31, Some doctors we not sure about that and told them I"ll look into it
    and let them know. Can you give me more info on that.

    Thank You Very Much!

    MsMaddy

  7. #7
    Default
    If a patient comes in for physical exam and no pelvic or pap is done but a breast exam is performed I code this V70.0 and V76.19. If a patient comes in for the same physical exam but a pelvic is performed I use V72.31. Is this how others are doing it?

    (Donna I notice you are in Duluth...I am in Brainerd! Small world! )

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    not many of us "minnesotans" on here - it seems! Nice to see one!
    Donna, CPC, CPC-H

  9. #9
    Location
    Loma Linda
    Posts
    50
    Default
    So when a pt comes in for Just for her Well Women exam (not Medicare) are you using 9921X and V72.31, V76.2 or G0101 and Q0091 and how are being reimbursed? We have this controversy because we will do the CPE 9938X and pt may go to another one of our docs for her Pap then what??
    I am finding most ins will only pay for 1 preventive CPT code per 365 days and if we break it down in 2 visits they have exceeded their limit.??????

  10. #10
    Location
    Green Bay, WI
    Posts
    48
    Smile
    So when a pt comes in for Just for her Well Women exam (not Medicare) are you using 9921X and V72.31, V76.2 or G0101 and Q0091 and how are being reimbursed? We have this controversy because we will do the CPE 9938X and pt may go to another one of our docs for her Pap then what??
    I am finding most ins will only pay for 1 preventive CPT code per 365 days and if we break it down in 2 visits they have exceeded their limit.??????[/QUOTE]


    If the patient comes in just for the pap and pelvic, and does not have the full physical exam,you would bill an office visit with Dx V72.31. G0101 and Q0091 should only be used if the patient has medicare.

    If the patient is seen for their CPE and the preventive code is billed, then they return to have their pap done, you would bill an office visit level for the pap.

    Hope this helps.
    Alaina
    [FONT=Arial][FONT="Comic Sans MS"]Alaina M. Byrne CPC, CPMA

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