Wiki Breast Exam Coding Question

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dan528i

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I've been having some issues billing Medicare for Breast Exam, the G0101 code. I've been billing this code with diagnosis V76.19, but it's being denied by Medicare for an "inappropriate diagnosis code." The CMS website lists the diagnosis codes V76.2 and V72.31 as compatible with the G0101, but I'm wondering if anyone knows whether these would be payable in conjunction with the 99213 and 99203 office visits.

Thanks, any help would be greatly appreciated.
 
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G0101 can be reported with an E/M code when a separately identifiable E/M service was provided.

Modifier -27 should be appended only to E/M service codes within the range 92002-92014, 99201-99499, and with HCPCS codes G0101 and G0175.
 
We are closing with V76.2 and V72.31 with clinc E/M codes . I am not sure about the payment part but I never heard anything from my Manager
 
dan528i said:
I've been having some issues billing Medicare for Breast Exam, the G0101 code. I've been billing this code with diagnosis V76.19, but it's being denied by Medicare for an "inappropriate diagnosis code." The CMS website lists the diagnosis codes V76.2 and V72.31 as compatible with the G0101, but I'm wondering if anyone knows whether these would be payable in conjunction with the 99213 and 99203 office visits.

Thanks, any help would be greatly appreciated.
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Ok, if I understand your question, you are billing out the G0101 and then billing out a 99213 or 99203 for another problem. If so, you need the modifier -25 on the problem E/M visit. The G0101 elements could not then be used for the E/M level as it is a separate service. However, if you are billing the G0101 and the 99213 or 99203 with the same V76.2 or V72.31 to Medicare the E/M's will be denied.

Here is a link to a great CMS Preventive Medicine Quick List that I provide to all of my offices.
http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
 
when we have madcr pts come in for a problem also we bill ex.. 99213 mod 25 G0101-v76.2 and if pap done too we bill the Q0091 with -59 modifier also and ours gets pd.We could not get the Q0091 pd with a problem visit they kept bundling so we put the -59 on it and verified with mdcr if ok to do,they get pd. If pt does not get pap just bill 99213 with -25 and G0101-v76.2 they should not bundle. Hope this helps!
 
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