Breast exam

jouanlychen

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Can anyone tell me what is the proper code to use for breast exam only? The patient was also in the office for other unrelated procedures. The patient has Medicare..we use S0413, but is not covered by Medicare:confused:
 

LindaEV

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Any exam would be inclusive of your office visit charge.

To charge separately, the breast exam would have to have been preventative and part of a G0101 exam, which has other requirements (pap/pelvic exam) and coverage guidelines.
 

jouanlychen

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Breast Exam

Well, the patient was in the office for rash issues, but the patient also has complaints about her breast lump that seems abnormal. This is not a preventative visit, but an office visit. The G0101 includes the pelvic exam which she was not in the office for. We have use S0613, however that is not cover by Medicare. Any suggestions?
 

LindaEV

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The breast exam is included in your office visit. Even if it is unrelated to the rash. It is just your second problem. It is not separately billable.

Think of it as the patient comes in for a hurt ankle and an earache, the doc examines the ear and the ankle...totally unrelated, but still all inclusive of your office visit charge.

Breast are just another body part to examine.
 

jouanlychen

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Unrelated Issues

From what I was told was that, if a patient comes into the office for issues that are unrelated, it should be billed as unrelated issues. It is payable if you append a modifier with it.:)
 

mitchellde

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From what I was told was that, if a patient comes into the office for issues that are unrelated, it should be billed as unrelated issues. It is payable if you append a modifier with it.:)
I am not sure what you are referencing. If the patient comes in for a scheduled procedure and then has unrelated complaints you may bill an office visit with a 25 modifier for the unrelated complaint. If the patient come in for an office encounter as stated above and also complains of something else while there it is just a second problem and may possibly increase the visit level, but there is no additional charge. So for the original issue you will have rash and breast lump as your dx and the level of service met by the guideline set you are using. So for instance the 95 guidelines say for a problem focused exam you need a limited exam of the affected area plus an exam of a related or SYMPTOMATIC area. Or ofr detailed you need a more extensive exam of the affected area plus a related or symptomatic area. So this will be either expanded focused exam or detailed depending on the documentation if using 1995. 1997 you will follow the bullets for the multi-system set and see how many bullets have been met. You may not charge 2 office visits on the same day. and there is no addtional way to charge for additional exam due to more complaints.
 
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