Wiki Annual Gyn Exam

[KoBee]

If a 65+ yrs old Medicare patient comes in for a routine annual gyn exam, pap smear is done and it went from a preventive visit to diagnostic visit, during pap a polyp was removed. Would you use modifier 33 on E/M?

 

[TatyanaNegovan]

Modifier 33 is procedure modifier; it is not applicable to E/M codes. The 99397/99387 is billed with polypectomy code 58558. However, the procedure code is required pre-authorization and may be denied.

 

[desireewhite185@yahoo.com]

Office visit with cervical polypectomy, I believe the CPT would be 57500.
Would you put a modifier 25 on the annual code? TY!

 

[nielynco]

Office visit with cervical polypectomy, I believe the CPT would be 57500.
Would you put a modifier 25 on the annual code? TY!

So this is a Medicare patient and Medicare will not pay for the preventive medicine codes, only G0101 and Q0091 assuming that was done and documented. If a procedure was done during this encounter you can bill 57500 but not a problem E/M if there is no significant evaluation going on in addition to the preventive services. Medicare might require a modifier -25 on the G code, but I am not aware of any rules that state this.