Primary Care Coding Alert
Bust Myth About Breast Exam Requirement
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 Subscriber Answer: 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 appearance, hair distribution, or lesions). 4. Urethral meatus (e.g., size, location, lesions, or prolapse). 5. Urethra (e.g., masses, tenderness, or scarring). 6. Bladder (e.g., fullness, masses, or tenderness). 7. Vagina (e.g., general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele). 8. Cervix (e.g., general appearance, lesions, or discharge). 9. Uterus (e.g., size, contour, position, mobility, tenderness, consistency, descent, or support). 10. Adnexa/parametria (e.g., masses, tenderness, organomegaly, or nodularity). 11. Anus and perineum. Remember, the coding for your encounter is correct provided the services don't violate Medicare's frequency guidelines. If you're unsure about a patient's status, get a signed advance beneficiary notice (ABN) on file before performing G0101 or Q0091. -- Information for and answers to You Be the Coder and Reader Questions reviewed by Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians in Leawood, Kan.
Primary Care Coding Alert
- Earwax-E/M Encounter Equals $47 More Per Removal Claim
Check for tools, impacted' cerumen for 69210 evidence. When a patient reports to the family [...] - Consider Observation Codes for Patients In Apparent Limbo
Medicare clears up confusion surrounding '8-hour rule.' Reporting your FP's observation services can be tricky [...] - ID NPP/FP 'Team-ups' for Shared-Visit Billing
Forget about incident-to in the facility, but consider this option. So you have all of [...] - You Be the Coder:
Hammer Hematoma Treatment Down With Terms
Question: An established patient presents to the FP after an accident; he crushed the tip [...] - Reader questions:
Check If Exceptions Exist in Fracture Modifiers
Question: An established patient reports to the FP with an injured right finger he suffered [...] - Reader questions:
Consider All Aspects for Hypothyroidism Dx
Question: An established patient who recently had surgery and radiation therapy to treat her thyroid [...] - Reader questions:
Remember Primary Dx Code for These Diabetics
Question: I have a puzzling claim in front of me. The notes indicate that the [...] - Reader questions:
Anemia Could Lead to H1N1 Admin
Question: An 18-year-old female established patient reports to the FP complaining of weakness and fatigue; [...] - Reader questions:
Bust Myth About Breast Exam Requirement
Question: The FP performs a well-woman examination with Pap smear for a low-risk 67-year-old Medicare [...]
