# 99214 and g0101 billed together



## TEANES (Apr 4, 2013)

We have a lady who came in with breast nodule/breast pain...our provider did a breast exam on her. My question is can you bill a e/m and breast exam on this patient or is it considered with the e/m b/c of the diagnosis? My provider said it is considered in e/m but to me a breast exam had to be done to determine plan of treatment. Thoughts?


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## cheermom68 (Apr 4, 2013)

G0101 is not the code for a breast exam.  There is not code just for a breast exam, except for S0613 which is usually not paid by any insurance except maybe BCBS.  G0101 is for a pelvic exam which includes the breast exam, but also requires a detailed pelvic exam.  If all he was doing was a breast exam for diagnostic purposes, he is correct, it is included in the E&M.


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## cheermom68 (Apr 4, 2013)

I would also be curious how he reached a 99214 for a breast nodule, unless there was other issues covered and a more extensive exam.


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## TEANES (Apr 8, 2013)

There were other issues positive ANA and insomnia for the E/M


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