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Bust Myth About Breast Exam Requirement

Published on Thu Feb 25, 2010

Question: The FP performs a well-woman examination with Pap smear for a low-risk 67-year-old Medicare patient. Notes indicate the FP addressed eight elements during the exam; however, I see no evidence of a breast exam. Can I still report the well-woman exam? Illinois SubscriberAnswer: Provided the patient is eligible for both services, you can report G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the well-woman exam, along with Q0091 (Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory) for the Pap smear.Explanation: Despite the descriptor, a breast exam is not required in order to report G0101. In order to report this code, the exam must include seven of the following 11 elements:1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge.2. Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses.3. External genitalia (general [...]
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