Clinical Review

Your age-based guide to comprehensive well-woman care

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The common sexual disorders in women are categorized as desire, arousal, orgasm, and pain disorders. There are two desire disorders: hypoactive sexual desire disorder and sexual aversion disorder. There are two arousal disorders: female sexual arousal disorder and persistent genital arousal disorder. There are four pain disorders: dyspareunia, vulvodynia, vaginismus, and noncoital nonsexual pain.

Most experts recommend that treatment of female sexual dysfunction include multiple modalities that reflect the complex biopsychosocial factors that cause the problem. For example, a treatment plan might include cognitive behavioral therapy, sex therapy, and appropriate medications.

Mental health issues

Depression, anxiety, bulimia, and anorexia nervosa are more common in women than men. For instance, the lifetime risk of depression in women is approximately 20%, compared with about 10% in men. The gender difference is first observed in adolescence and becomes minimal after age 60. The gender differences are observed across racial and ethnic groups.26

It's on us

As leaders in women's health care, we are uniquely trained to guide, counsel, diagnose, and treat women across their entire lifetime, from adolescence to postmenopause. We are at the vanguard in the effort to continually improve the health of all women.

Preventive coding can be a snap

Melanie Witt, RN, CPC, COBGC, MA

Coding and billing for the care provided at a well-woman visit can be uncomplicated if you know the right codes for the right program. Here, I present information for straightforward preventive care. (I am assuming the patient has not also presented with a significant problem at the same visit.)

First, a patient who is not Medicare-eligible should have the annual well-woman exam billed using the CPT preventive medicine codes. There are some private insurers, however, that will only accept HCPCS codes for an annual gyn exam. These special codes are:

S0610 Annual gynecological examination, new patient

S0612 Annual gynecological examination, established patient

S0613 Annual gynecological examination; clinical breast examination without pelvic evaluation

Notably, Aetna Cigna, and United Healthcare require these codes for a gyn exam, but many BC/BS programs, for whom these codes were originally created, are now reverting to the CPT preventive medicine codes for all preventive care.

The CPT preventive codes are grouped by age and require an age- and gender-appropriate history, examination, and counseling/anticipatory guidance. The Medicare E/M documentation guidelines do not apply to preventive services, and a head-to-toe examination is also not required. CPT recognizes ACOG as an authoritative body to make recommendations for the expected preventive service for women, and if such a service is provided and documented, the preventive codes are to be reported.

The chart below summarizes the CPT preventive codes by patient status and age in comparison to ACOG age groupings.

New Patient Preventive Medicine Code
New patient codes include an initial comprehensive preventive medicine evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures
ACOG: 13–18 years 99384 (12–17 years) 99385 (18–39 years)ACOG: 19–39 years 99385 (18–39 years)ACOG: 40–64 years 99386 (40–64 years)ACOG: 65 years and older 99387 (65 years and older)
Established Patient Preventive Medicine Codes
Established patient codes include periodic comprehensive preventive medicine reevaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures
ACOG: 13–18 years 99394 (12–17 years) 99395 (18–39 years)ACOG: 19–39 years 99395 (18–39 years)ACOG: 40–64 years 99396 (40–64 years)ACOG: 65 years and older 99397 (65 years and older)

The main code

The appropriate diagnostic link for the CPT preventive gyn annual well-woman exam is V72.31, whether or not a Pap specimen is collected. The collection of the Pap specimen is included in the preventive service, as is counseling regarding birth control, or general questions about preventing problems, including hormone replacement therapy.

If a pelvic examination is not performed, say because the patient is young and not sexually active, but an examination of other areas is carried out, the same preventive codes are reported, but the diagnosis code changes to V70.0, general health exam.

What about Medicare?

Coding. Medicare requirements are somewhat different. First, Medicare covers only a small portion of the preventive service; that is, they cover a physical examination of the genital organs and breasts and the collection and conveyance of a Pap specimen to the lab in the covered year only. Think of the complete preventive service as described in CPT as a pie—Medicare pays for 2 slices of that pie in a covered year. The two codes for these services are:

G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination)

Q0091 (Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory)

If the patient is at low risk for developing cervical or vaginal cancer, the screening pelvic exam and Pap collection are paid every 2 years. If the woman is at high risk, Medicare will cover this portion of the encounter every year. The high-risk criteria must be re-documented every year and must include one of the following:

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