Gastroenterology Coding Alert

Question: I had a Medicare beneficiary ask for a prostate exam. Our doctor dictated the exam as a yearly physical with no other complaints. What do I charge?

Michigan Subscriber

Answer: Use G0102 (Prostate cancer screening; digital rectal examination) and diagnosis code V76.44 (Special screening for malignant neoplasms; prostate).Medicare will pay for the exam only if it is the only thing the patient came in for. If that patient wants a screening digital rectal exam (DRE) done in conjunction with a problem visit, the DRE is bundled into an office visit (such as 99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

FYI: All Medicare beneficiaries aged 50 or older are eligible for G0102 once per year, but they must pay their copayment and/or coinsurance deductible. A prostate specific antigen (PSA) test (G0103) is likewise covered for beneficiaries aged 50 or older, once per year, with no deductible and no copayment/coinsurance. Be sure the patient knows these services are covered once a year.