Wiki Medicare GYN Exam- G0101

[NicoleSprecher]

Hello,

I was asked by one of our physicians to explain in more detail what is all included within a G0101- Breast and Pelvic Exam.
For starters, our physicians see quite a few Medicare patients for breast and pelvic exams and up to this point have been billing the G0101 only but also ordering mammograms, lab orders, and/or monitoring previous stable conditions.
I have tried doing quite a bit of research but unable to find an exact answer for this question through Medicare guidelines. Is anyone able to help with this?
Wondering- if it is okay to bill for E&M code in addition to G0101 when provider performs the above-mentioned services?

Thank you in advance!

 

[csperoni]

If you are treating chronic stable conditions, then yes, you may bill and E&M along with G0101. Your G0101 would have your Z diagnosis linked. Your E&M would have your diagnosis for the problems treated linked. Modifier -25 would be required on the E&M to prevent a bundling denial. Remember for -25, you must have a significant and separately identifiable service, which should be the case if you are treating other chronic stable conditions (or any condition really).
It would not be appropriate to bill 99202-99215-25 if there is no treatment of problems.