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Question reg. G0101

  1. Default Question reg. G0101
    Medical Coding Books
    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.

  2. #2
    Actually the acceptable way to code this is:

  3. Default
    actually this is Oxford for NYState not medicare

  4. #4
    Kansas City, MO
    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.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  5. Default
    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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