Primary Care Coding Alert

Question: My family physician performs a breast and pelvic exam on a Medicare patient and collects a Pap smear that he sends to a laboratory. Should I report G0101 and Q0091? How often will Medicare cover the services?

Nebraska Subscriber

Answer: Yes, you may report both G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the exam and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for the Pap smear collection and handling.

Medicare allows billing both services at a frequency based on the patient's risk factor. For normal-risk patients, Medicare will cover the exam and screening every two years. If the patient meets Medicare's high-risk criteria, such as early sexual activity or abnormal Pap smears, the carrier will cover annual exams.

- Answers to Reader Questions and You Be the Coder provided by Jean Chasin, owner of MD Solutions, a billing service in Arlington Va.; Jami Lucas, allergy coding executive director in Washington, D.C.; and Teresa Thompson, CPC, CCC, president of TM Consulting in Carlsburg, Wash.