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Deleting G0101 and billing only E/M????Medicare Help!!


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Where is the guideline for the below statement??? I have looked everywhere. I know it's right I just would like to be able to find the guideline. And for that how come I couldn't do a -25 modifier with a seperate E/M?? Thanks for any help!:eek:

Delete G0101 and Q0091- Screening only- if patient presents with symptoms and a GU exam performed- Report only E/M


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I am not sure I understand your question but if you look in "The guide to Medicare Preventive Services" under Pelvic Screening Exam it gives you all the information on these two codes. You can also bill an E&M with a 25 modifier on the same day as G0101 and Q0091. Look under "Coding Tips" in the Pelvic Screening Exam section "The same physician may report a covered E&M on the same day if the E&M is for a separately identifiable service".


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Thanks...not sure either/Medicare confusion

Well, maybe this will help. We are on EHR, and my Dr. has to code for his/herself and when we are audited I am not allowed to "help" him with his/her coding because it is ultimately up to the Dr. to choose the correct codes. Honestly though when I am doing charge entry I can ask for them to append it to the correct code and the Dr. then does so in EHR, and all is OK. The auditor in this case, gave that comment, as above, and I DO NOT understand it myself. (Delete G0101 and Q0091- Screening only- if patient presents with symptoms and a GU exam performed- Report only E/M) Why can't I bill a wellness G0101 and then do a seperate E/M with modifier -25??? Thanks for ANY help....I really appreciate it.

History of Present Illness:
C/O Leg Swelling Left Leg,
Spotting only when she wipes.

She has noted some light vaginal bleeding since Dec. 27. She does not take any hormones.
She has had a recent Urology referral for hematuria.

Past Surgical History:

Review of Systems

Complains of weight loss.
Denies weight gain, fever, and fatigue.

Denies vision change-spots.
Wears Glasses

Complains of sinusitis.
Denies bleeding from gums, headaches, mouth ulcers, and hearing loss.

Denies chest pains, palpitations, syncope, dyspnea on exertion, orthopnea, PND, and peripheral edema.

Complains of difficulty breathing with activity and cough.
Denies shortness of breath, wheezing, and coughing up blood.

Complains of indigestion.
Denies constipation, diarrhea, gas, blood in stool, abdominal pain, nausea-vomiting, and involuntary loss of stool-gas.

Denies pain with intercourse, vaginal discharge, heavy periods, painful periods, vaginal itching, blood in urine, involuntary loss of urine, and urgency or pain with urination.

Denies muscle pain, muscle weakness, muscle numbness, seizures, fainting spells, trouble walking, and .

Vital Signs:

Patient Profile: 72 Years Old Female
Height: 66 inches
Weight: 203 pounds
Pulse rate: 82 / minute
BP sitting: 113 / 68 (left arm)
Cuff size: regular

Pt. in pain? no

Physical Exam

abdomen soft and non tender, no hepatosplenomegaly or masses noted

CX is too stentic to perform a Pap or EMBX.

Preventive Care Screening

New Orders:
Pelvic/breast exam Medicare (CPT-G0101) Due: 01/25/2010
99203 new detailed (CPT-99203) Due: 01/25/2010

Impression & Recommendations:

Problem # 1: Menopausal Uterine Bleeding

Medications Added to Medication List This Visit:
1) Simvastatin 20 Mg Tabs (Simvastatin) .... Take one tablet/capsule by mouth every day
2) Alendronate Sodium 35 Mg Tabs (Alendronate sodium) .... 1 po weekly

Other Orders:
Pelvic/breast exam Medicare (CPT-G0101)
99203 new detailed (CPT-99203)

Patient Instructions:
1) No specific follow-up needed for this problem. However please do not hesitate to call office with any questions or concerns, or follow-up as needed.
2) I rec we perform her Pap and sample endometrial tissue by performing a D&C


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A screening pelvic examination (G0101) with or without specimen collection for smears and cultures, should include at least seven of the following eleven elements:

o Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge; and

o Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses.

o External genitalia (for example, general appearance, hair distribution, or lesions);
o Urethral meatus (for example, size, location, lesions, or prolapse);
o Urethra (for example, masses, tenderness, or scarring);
o Bladder (for example, fullness, masses, or tenderness);
o Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele);
o Cervix (for example, general appearance, lesions or discharge)
o Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support);
o Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity); and
o Anus and perineum.

**Note** You bill the G0101 for "screening" pelvic exams. Your problem addressed was for Menopausal Uterine Bleeding so, that is why they're saying to remove the G0101 and Q0091 as it wouldn't be applicable in your scenario. :)