Wiki Screening pelvic exam

[MACACERES]

Hi,

I hope someone can help me. Does the breast check/exam have to be one of the seven elements out of eleven required for the screening pelvic exam (G0101)? I can't seem to find something definitive on this. On the Medicare website there is something, but I've also seen some info stating it does need to be one of the seven.

I also read something stating that it was no longer required in 2008, but then a colleague said they reinstated it. Is that true?

Please help.

 

[leannm21]

Here are the Eleven criteria for the G0101 code, it just has to be 7 out of the 11 below (I work for a Medicare Advantage plan so I checked the guidelines for you):

1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge

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

3. External genitalia (for example, general appearance, hair distribution, or lesions)

4. Urethral meatus (for example, size, location, lesions, or prolapse)

5. Urethra (for example, masses, tenderness, or scarring)

6. Bladder (for example, fullness, masses, or tenderness)

7. Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele)

8. Cervix (for example, general appearance, lesions or discharge)

9. Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support)

10. Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity)

11. Anus and perineum

 

[MACACERES]

Screening Pelvic Exam

Thank you. I understand what the 11 elements are; my question was whether the breast check had to be one of the 7 or if any random seven qualified.? It used to be that the breast check had to be one of the 7 out of 11.