A 28-year-old established patient comes to your office for her well-woman examination. You take the patient's interval medical, family and social history and perform a complete review of systems. You also perform a physical examination that includes a blood-pressure check and thyroid, breast, abdominal and pelvic examinations, and you obtain a Pap smear. The patient is on oral contraceptives and has concerns about intermittent break-through bleeding. You counsel the patient regarding alternatives and give her a prescription for a new medication. You also counsel the patient about diet, exercise, substance abuse and sexual activity. Then you send the Pap smear to an outside laboratory that will bill the test directly to the payer. Although the patient has concerns about her current method of birth control, the associated counseling and change in medication is considered part of the preventive medicine service for her age group, so you should submit 99395, "Periodic comprehensive preventive medicine ..., established patient; 18-39 years," and ICD-9 code V72.3, "Gynecological examination."

Bill	Diagnosis code(s)	Procedure code(s)
Patient	V72.3 Gynecological examination	99395 Preventive service

A 52-year-old established patient presents for an annual exam. When you ask about his current complaints, he mentions that he has had mild chest pain and a productive cough over the past week and that the pain is worse on deep inspiration. You take additional history related to his symptoms, perform a detailed respiratory and CV exam, and order an electrocardiogram and chest X-ray. You make a diagnosis of acute bronchitis with chest pain and prescribe medication and bed rest along with instructions to stop smoking. You document both the problem-oriented and the preventive components of the encounter in detail. You should submit 99396, "Periodic comprehensive preventive medicine ..., established patient; 40-64 years" and ICD-9 code V70.0, "Routine general medical examination at a health care facility"; and the problem-oriented code that describes the additional work associated with the evaluation of the respiratory complaints with modifier -25 attached, ICD-9 codes 466.0, "Acute bronchitis" and 786.50, "Chest pain" and the appropriate codes for the electrocardiogram and chest X-ray.

Bill	Diagnosis code(s)			Procedure code(s)
Patient	V70.0	Routine exam	99396	Preventive service
	466.0	Acute bronchitis	99213-25*	Office outpatient E/M service for established patient
	786.50	Chest pain
			93000	Electrocardiogram
			71020	Chest X-ray, PA and lateral

*The level of service represents only an example. The level reported should be determined by the documented history, exam and/or medical decision making.

A 65-year-old established Medicare patient presents for her annual well-woman exam. Medicare covers the collection of a screening Pap smear and her pelvic exam and clinical breast check for that year. You should submit the following codes (and related charges) to Medicare: G0101 for the pelvic exam and clinical breast check, Q0091 for the collection of the Pap smear specimen and V76.2, "Special screening for malignant neoplasms; cervix"; and the following codes (and related charges) to the patient: 99397, "Periodic comprehensive preventive medicine ... established patient, 65 years and over," and V72.3, "Special investigations and examinations; gynecological examination." The total amount billed and received for this visit should equal your usual charge for an annual exam of $100.

Bill	Diagnosis code(s)		Procedure code(s)		Charge
Medicare	V76.2	Special screening formalignant neoplasms; cervix	G0101	Pelvic exam and clinical breast check	$36.60
			Q0091	Collection of Pap smear specimen	$37.70
Patient	V72.3	Gynecological examination	99397	Preventive service	$25.70
Total amount billed and received					$100.00

An established Medicare patient presents for management of hypertension and preventive services. Medicare covers the full allowable amount for all reported services. You should submit the following codes and related charges to Medicare: G0101 for the pelvic exam and clinical breast check, Q0091 for the collection of the Pap smear specimen and V76.2; and 99213 for the established-patient office visit (with modifier -25 attached) and 401.1, "Essential hypertension, benign." The total amount billed for this visit should be $127.30.

Bill	Diagnosis code(s)		Procedure code(s)		Charge
Medicare	V76.2	Special screening for malignant neoplasms; cervix	G0101	Pelvic exam and clinical breast check	$36.60
			Q0091	Collection of Pap smear specimen	$37.70
	401.1	Hypertension, benign	99213-25*	Office visit	$53.00
Total amount billed and received					$127.30

*The level of service represents only an example. The level reported should be determined by the documented history, exam and/or medical decision making.

A 46-year-old established patient, who was seen six months ago for a health maintenance visit, is in overall good health and is within 10 percent of his ideal body weight, comes to your office to discuss a diet and exercise program. The patient is now interested in a regular exercise program and diet to reduce his risk of cardiovascular disease since his 52-year-old brother recently had a heart attack. You spend 15 minutes discussing these issues with him. You should submit the appropriate preventive medicine counseling code for this visit and ICD-9 codes V65.3 and V65.41.

Bill	Diagnosis code(s)		Procedure code(s)
Patient	V65.3	Dietary surveillance and counseling	99401	Preventive medicine counseling
	V65.41	Exercise counseling

This table lists some of the preventive screening services that are covered by Medicare. It shows the covered frequency and the associated HCPCS and ICD-9 codes that should be submitted for each service. (For information about other Medicare-covered screening services, go to http://www.medicare.gov/health/overview.asp.)

Screening service	Frequency	HCPCS code	ICD-9 code
Screening pelvic and clinical breast exam	Once every 2 years; once every year for high-risk patients*	G0101	V76.2, V76.47, V76.49 or V15.89
Screening Pap smear	Once every 2 years; once every year for high-risk patients*	Q0091	V76.2, V76.47, V76.49 or V15.89
Digital rectal exam	Once every 12 months for patients 50 years or older	G0102	V76.44
PSA	Once every 12 months	G0103	V76.44
Fecal occult blood test	Once every 12 months	G0107 G0328	V76.41 V76.51

*Medicare's definition of "high risk" includes patients of childbearing age in which cervical or vaginal cancer is or was present or other abnormalities have been found in the preceding three years and patients with one or more of the following high-risk factors for either cervical or vaginal cancer: onset of sexual activity under 16 years of age, five or more sexual partners in a lifetime, history of sexually transmitted diseases (including HIV), fewer than three negative Pap smears within the previous seven years, no Pap smears at all within the previous seven years or prenatal exposure to DES.