Forum - Questions & Answers

May 16th, 2012 - TerryC 39 

2nd plea for help, well woman exam

When a OBGYN is doing a well woman exam on a patient how is the best to code this. Sometimes they just come in for a "pap" only, we use G0101/V72.31. If they discuss contraceptive options or maybe hormone replacement, or other "female" problems, how is the best to code these. Can we use the G0101 for the pap and an E/M code for the other "female" problems eg: 627.2,V07.4,616.10. our billing department says if the problems are "female" related it should all be covered under the G0101. The insurance company's say it is all "related to the G0101 female exam. This doesn't seem fair if the doctor is spending extra time talking about other "female" issues. Someone had said that the G0101 is for medicare patients only. That is not my understanding. Especially now with digital mammo's those codes are only G-codes. Also can the OBG doctor bill for the "physical codes like 99395" or what all would need to be in his notes re: the physical? Thank you sorry so long.

May 17th, 2012 - Codapedia Editor 1,399 

re: 2nd plea for help, well woman exam

G0101 is only for the pelvic and clinical breast exam. It does not include history or A/P related to a complaint. A complaint is billed separately.

Some GYN doctors bill in the 9938X or 9939X series of codes. There isn't a written guideline about what they have to include in CPT®. It is an age/gender appropriate history and physical exam with risk factor reduction, anticipatory guidance and referral for or provision of immunizations and screening tests.

Please search "well woman" and G0101 in the search box for articles on this topic.



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