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Wiki Medicare wellness visit

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obgyn1

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When billing for Medicare wellness visits. To bill just the G codes with using G0101. Does the pelvic and breast exam both have to be done. Example pt come in for her Medicare annual exam using coding G0439. The doctor only does exam from waist up. Does not do pelvic exam. Please help.
 
So both breast & pelivc has to be done even if it's not time for pap and we can not charge g0101.
Why i am asking me and my co-worker disagree to this coding. She said for just g0439 they do not have to do both breast & pelivc exam.
 
She would be correct.

G0439- Subsequent annual wellness visits (AWV) include updating the patient's medical and family history, updating the current provider list, obtaining the patient's vital signs and weight, identifying cognitive impairment, updating the screening schedule, updating the risk factors list, and providing personalized health advice to the patient.

You would code for the pelvic/breast exam separately w/ G0101 and if a pap is done you would use Q0091.

According to the correct coding initiative(cci) you can append modifier 52 (reduced services) to G0101.
 
Medicare Breast and Pelvic exam

according to ACOG in order code the g0101 code the provider must examine 7 of the 11 breast or pelvic elements. If the provider only does a breast exam that would only be 2 elements therefore you would not be able to code g0101.
 
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