Internal Medicine Coding Alert
Billing for a Screening Test
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Question: A patient is being seen for the management of hypertension and care of frequent urination at night. A rectal exam is done to evaluate the prostate. Can our practice bill an evaluation and management (E/M) code with modifier -25 attached along with G0102?
Nancy Barber
New Port Richey, Fla.
Answer: You cannot bill separately for G0102 (prostate cancer screening; digital rectal examination) at the time of a problem oriented E/M service, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C. The digital rectal exam becomes a portion of the exam rendered on that day. G0102 was designed to provide a mechanism for billing Medicare for the covered portion of an annual exam for men, and can only be billed in conjunction with a code from preventive medicine services, 99381-99397.
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