AWV with prostate exam

nc_coder

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I am billing G0438(9) with G0102. The G0102 is denying as bundled. I cannot find anything on the medicare website where this cannot be filed together. How do I bill the prostate exam with the AWV?
 
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Macomb, Michigan
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Check the NCCI policy manual

HCPCS code G0102 (Prostate cancer screening; digital rectal examination) is not separately payable with an evaluation and management code (CPT codes 99201-99499). CMS published this policy in the Federal Register, November 2, 1999, page 59414 as follows:
“As stated in the July 1999 proposed rule, a digital rectal exam (DRE) is a very quick and simple examination taking only a few seconds. We believe it is rarely the sole reason for a physician encounter and is usually part of an E/M encounter. In those instances when it is the only service furnished or it is furnished as part of an otherwise non-covered service, we will pay separately for code G0102. In those instances when it is furnished on the same day as a covered E/M service, we believe it is appropriate to bundle it into the payment for the covered E/M encounter.”
 

mitchellde

True Blue
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There is a Med learn Matters article that was published last year that states specifically that you bill the AWV in addition to the G0102. You need the timing there if you are short of one year from the previous then it will not pay and you link it to the V code for prostate screening not to the V70.0.
 
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