Forum - Questions & Answers

May 6th, 2011 - CarolAnn8

Routine Pelvic Exam

How do I code a Routine pelvic/breast exam. Pap Smear, GC/Chlam DNA Amp performed and specimens sent out to laboratory to bill insurance directly. Wet Mount performed in the office. She is an established patient. she returns to the office requesting a routine pap smear, no history of pelvic pain. The physician notes also states in the history that previous sinusitis symptoms have resolved and she has no acute cardio-pulmonary symptoms. PMH of HBP. The patient was given a rx for screening mammogram. Previous lab results discussed and the patient was continued on prescribed enalapril medication. I am billing a commercial payor.

You could give me the answer if I was also going to bill this same senario to Medicare, Please :)

May 7th, 2011 -

re: Routine Pelvic Exam

For commercial, V72.31 as ICD, 9938x for the CPT®. There was not enough service to also bill a 99213 for the HTN

I don't have my medicare cheat sheet with me- stay tuned

May 9th, 2011 -

re: Routine Pelvic Exam

For Medicare pap/breast exam, G0101 linked to V72.31, Q0091 linked to V72.31 for the "conveyance of pap to lab" and you can bill the colon cancer screening if a stool specimen was collected.

May 10th, 2011 -

re: Routine Pelvic Exam

Thank you.. This helps a lot. :)

Feb 2nd, 2012 - javed0076 1 

re: Routine Pelvic Exam

I have 1 PT with BCBS ins, cuming today for PAP exam. Dr Billed 99214, G0101, and Q0091. Can u please let me know that BCBS paying G0101 or I have to bill P3000???

can u please help me??

Feb 2nd, 2012 - Codapedia Editor 1,399 

re: Routine Pelvic Exam

You need to check with your local BCBS policy for the answer to your question. Local BCBS plans set their own policies.

99214 is a problem oriented visit, not a preventive medicine service.



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