Practice Management Alert

Question: I'm having trouble getting rectal-exam claims paid by Medicare. Are they bundled into office visits? The exams have a code, and Medicare says they'll reimburse it, but I'm not seeing payment. Do you have any explanation? Indiana Subscriber Answer: Yes, often the rectal exam is bundled into the office visit. You essentially can't get paid for it, except if the patient receives the exam on the same day as a physical. Then you can subtract out the cost from the physical, bill to Medicare and reduce the patient charge for the physical exam.

However, if the patient has a rectal exam on the same day as an office visit, during which the patient discusses his hypertension, for example, then you won't get paid separately for the rectal exam.

Though there's a code and Medicare says it will reimburse, you'll have a hard time getting paid even harder than you do for Pap and pelvic exams. If you do a Pap smear or a pelvic exam on the same day as an office visit, Medicare will pay you for both in the same day. But if your male patient needs a digital rectal exam as you treat him for hypertension, you won't get paid from Medicare, so don't bother billing for it. You be the Expert and Reader Questions reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J. Answers contributed by Victoria Jackson, administrator and CEO of Southern Orange County Pediatric Associates in Lake Forest, Calif.; Betsy Nicoletti, CPC, a consultant with Helms, in Concord N.H.; Bill Sarraille, an attorney at Arent Fox Kintner & Kahn in Washington, D.C.; and Pam Sharkey, billing manager for an orthopedic and pain management practice in Paramus, N.J. $ $ $