Ob-Gyn Coding Alert

Effective January 1, 1999, changes in the Medicare payment policy for now allow for the billing of an E/M problem visit at the same time a Medicare patient is seen for a preventive service coded with G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination). A HCFA memorandum (HCFA Pub. 60 B) addresses edits for both G0101 and for Q0091 (screening Pap smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). The Q0091 edits do not go into effect until April 1, 1999, and will be addressed in the March issue of OCA.

Before Jan 1, 1999, CCI edits were set so that an E/M visit and code G0101 could not be reported by the same physician for the same date of service. If a Medicare patient presented for a scheduled appointment for cervical or vaginal cancer screening, pelvic and breast exam, and at that same visit also presented with a problem, you were not permitted to report both G0101 and the evaluation and management services code. For example, if a patient was coming in for her preventive pelvic/breast exam, and during that exam stated that she was having difficulty swallowing and had a raspy voice, the physician was faced with a problem. Since it was not permitted to code for both a G0101 and an E/M service on the same day, the physician had to just code for one of the services or have the patient make another appointment on a different day to be seen for the problem.

The memorandum states: This billing requirement is being changed. Effective with the CCI update for January 1, 1999, G0101 is allowed with an E/M visit if the visit is separate from the G0101 service. When both services occur at the same encounter for distinct reasons, modifier -25 should be utilized on the claim.

ACOG lobbied to have this change, says Melanie Witt, RN, CPC, MA, Program Manager for ACOGs Department of Coding and Nomenclature. Were pleased that Medicare finally agrees that the evaluation of a problem at the time of a screening exam involves significant additional work. If the patient presents with a problem, the physician should be able to bill for both the preventive service and the problem.

Heres how it works. In the situation where a patient is being seen for her Medicare preventive pelvic/breast exam but also presents with the difficulty swallowing and raspy voice, you will code the G0101 linked to the diagnosis code V76.2 (screening for malignant neoplasms cervix). In addition, you will code the appropriate level of E/M service (99211-99215) appended by the 25 modifier (separately identifiable E/M service, same day and physician) linked to the 787.2 (dysphagia, difficulty swallowing) and 784.49 (hoarseness).

Note: If additional noncovered preventive services are provided on the same day, such as extensive menopausal counseling, these services would then be billed directly to the patient.