Screening Pelvic Exam

[j.berkshire]

I'm auditing a note in which the physician documents the exam of 5 elements of the screening criteria for screening pelvic exam. Since 7 are required to bill G0101, would anyone suggest billing G0101-52? Is there another option for billing this physician service?

[kbarron]

Did he examine the breast also?

[amjordan]

Modifier -52 is not a valid modifier for G0101. If 7 of the 11 elements aren't documented, then you don't have a billable service based on the G0101 guidelines.

[j.berkshire]

No, he did not examine the breasts. Why isn't 52 modifier appropriate? Is that anywhere in the regs? I couldn't find anything in the Medicare Carriers' Manual. I hate to see physicians provide services and not be able to bill for them.

[amjordan]

I might have spoken to soon. My carrier is WPS and they do not allow -52 on any E/M service and G0101 is considered the covered portion of a preventive E/M service. Now, your carrier may be different.

[j.berkshire]

You're right, Angela. My carrier, Palmetto, indicates the 52 modifier cannot be used for E&M services. Thanks for the insight. (I still hate to give up on billing a physician service.)