Ob-Gyn Coding Alert

HCFA recently announced a change that will affect all ob/gyns who treat Medicare patients. Medicare Program Memorandum 1823, released on Feb. 1, 2001, brings welcome changes to the rules for billing for screening pelvic and breast examinations as well as Pap smears. Effective July 1, 2001, Medicare will pay for G0101 (cervical or vaginal cancer screening; pelvic and clinical breast exam) and Q0091 (screening Pap smear;, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) every two years, rather than every three years, when the woman is in a low-risk category under Medicare rules.

Under the old policy, which went into effect in January 1998, only those women deemed by Medicare to be at high risk for cervical or vaginal cancer were eligible for a screening exam more frequently than every three years. The new policy means that all women enrolled in Medicare are eligible for G0101 and Q0091 23 months after their last examination or Pap smear.

According to the memo (available online at www.hcfa.gov/pubforms/transmit/R1823A3.pdf), V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites) are still the appropriate diagnostic codes to pair with G0101 and Q0091.