Advanced Search

Primary Care Coding Alert

Reader questions:

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 [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Primary Care Coding Alert

View All