Wiki Question reg. G0101

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dan528i

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Hello
I am wondering if someone can tell me that this is correct.
1. Ptn present in OB/GYN office w/ c/c Irregular Period. New ptn- so bill E&M 99203-25 dx code 626.4.
2. while she is here she has a full medical c/u AND A Breast/Pelvic CA screening exam=G0101 Dx V76.19.

Ins comp denying the G0101 as insidental to 99203-25. after speaking to a rep at ins comp. I was told that if this was an unrelated procedure (G0101 that is) then a mod (I m not sure which one but I think 25) should be added not only to the E&M code but to G0101 as well.

Is this true?? Can some please help.

Thank you.
 
Actually the acceptable way to code this is:
G0101 (ONLY) W/ DX V76.17 (FIRST), 626.4(SECOND). MEDICARE IS RIGHT IN THE INSIDENTAL.
 
I don't believe that their is any modifier that can be used. The -25 can only go on the E/M service and the G0101 is not considered an E/M. If they recognize the use of the G code, then they may want of of the HCPCS modifier.

I think the denial is based on the fact that you have a new patient with a diagnosis of 626.4 and you are basically saying that it didn't require a pelvic. However, you did a pelvic for a screening.

The exam for a 99203 is Detailed, which requires an "Extended exam of affected body area or organ systems and other symptomatic or related organ systems." You may need to take a close look at the note, because the exam that was done cannot be used to support the exam for the 99203 and the elements of the G0101.
 
I have a total of 3 pg Complete medical history report. And 99203 (that was dealing w/ 626.4) has its own notes/recomindations/RXs/ referals and etc. The pelvic/breast exam was performed because my doctor performs one for every ptn ones a year. That part has its own section on the history report and was properly (or so i think) documented.

Thanks again for all the help. AAPC rules :)
 
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