Results 1 to 5 of 5

Breast Exam Coding Question

  1. Default Breast Exam Coding Question
    Medical Coding Books
    I've been having some issues billing Medicare for Breast Exam, the G0101 code. I've been billing this code with diagnosis V76.19, but it's being denied by Medicare for an "inappropriate diagnosis code." The CMS website lists the diagnosis codes V76.2 and V72.31 as compatible with the G0101, but I'm wondering if anyone knows whether these would be payable in conjunction with the 99213 and 99203 office visits.

    Thanks, any help would be greatly appreciated.

  2. #2
    Default
    Annotations

    G0101 can be reported with an E/M code when a separately identifiable E/M service was provided.

    Modifier -27 should be appended only to E/M service codes within the range 92002-92014, 99201-99499, and with HCPCS codes G0101 and G0175.
    Coding Junkie

  3. #3
    Default
    We are closing with V76.2 and V72.31 with clinc E/M codes . I am not sure about the payment part but I never heard anything from my Manager

  4. #4
    Location
    Kansas City, MO
    Posts
    751
    Default
    Quote Originally Posted by dan528i View Post
    I've been having some issues billing Medicare for Breast Exam, the G0101 code. I've been billing this code with diagnosis V76.19, but it's being denied by Medicare for an "inappropriate diagnosis code." The CMS website lists the diagnosis codes V76.2 and V72.31 as compatible with the G0101, but I'm wondering if anyone knows whether these would be payable in conjunction with the 99213 and 99203 office visits.

    Thanks, any help would be greatly appreciated.
    Ok, if I understand your question, you are billing out the G0101 and then billing out a 99213 or 99203 for another problem. If so, you need the modifier -25 on the problem E/M visit. The G0101 elements could not then be used for the E/M level as it is a separate service. However, if you are billing the G0101 and the 99213 or 99203 with the same V76.2 or V72.31 to Medicare the E/M's will be denied.

    Here is a link to a great CMS Preventive Medicine Quick List that I provide to all of my offices.
    http://www.cms.hhs.gov/MLNProducts/d...nceChart_1.pdf
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  5. Default
    when we have madcr pts come in for a problem also we bill ex.. 99213 mod 25 G0101-v76.2 and if pap done too we bill the Q0091 with -59 modifier also and ours gets pd.We could not get the Q0091 pd with a problem visit they kept bundling so we put the -59 on it and verified with mdcr if ok to do,they get pd. If pt does not get pap just bill 99213 with -25 and G0101-v76.2 they should not bundle. Hope this helps!

Similar Threads

  1. annual exam w breast exam only
    By OBcoder2017 in forum OB/GYN
    Replies: 1
    Last Post: 04-11-2014, 05:09 PM
  2. Replies: 8
    Last Post: 12-09-2011, 02:30 PM
  3. Coding Question-Breast revision Reconstruction
    By patti4docs in forum Billing/Reimbursement
    Replies: 0
    Last Post: 05-19-2010, 11:46 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.