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!

 

[lgardner]

per CMS NCD on pap and pelvic:
A screening pelvic examination (including a clinical breast examination) should include at least seven of the following eleven elements:

• Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge.
• Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses. Pelvic examination (with or without specimen collection for smears and cultures) including:
• External genitalia (for example, general appearance, hair distribution, or lesions).
• Urethral meatus (for example, size, location, lesions, or prolapse).
• Urethra (for example, masses, tenderness, or scarring).
• Bladder (for example, fullness, masses, or tenderness).
• Vagina (for example, general appearance, estrogen effect, discharge lesions, pelvic support, cystocele, or rectocele).
• Cervix (for example, general appearance, lesions, or discharge).
• Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support).
• Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity).
• Anus and perineum
• _______________________________________

this is called the 7 out of 11 rule.
yes and E/M can be billed with G0101, but it only if there is a "separately and signaficantly identifiable service" above and beyond the p&p.

 

[csperoni]

I answered in your original post: https://www.aapc.com/discuss/threads/medicare-gyn-exam-g0101.191134/
For future reference, please post questions only once, it whatever forum you think is most appropriate. Posting duplicates creates issues like this where you wind up with 2 threads for the same question.