Primary Care Coding Alert

Question: A new coder joined our staff and said that if we assigned the G0101 code during an office visit, it would not be paid because of the other evaluation and management (E/M) code that would be assigned for that day. Can you explain?

New Hampshire Subscriber

Answer: The new staff member is incorrect. Both a G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) and the appropriate level of E/M service can be reported on the same day.

A recent Health Care Financing Administration (HCFA) program memorandum (HCFA Pub. 60B) clearly states: Effective with the CCI [Correct Coding Initiative] update for Jan. 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 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be used on the claim.

Example: A 66-year-old woman is seen by her family physician because she is experiencing seasonal allergy symptoms. While in the office, she asks for a long-overdue breast exam and Pap smear. This scenario would be reported with G0101 and 99213 (office or other outpatient visit, established patient). Modifier -25 would be appended to 99213.

As of April 1, 1999, the same applies to Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).

Answered by Tammy Chidester, CPC, billing supervisor, Upshur Medical Management Services Inc., in Buckhannon, W.Va.