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Screening Pelvic Exam

  1. #1
    Default Screening Pelvic Exam
    Medical Coding Books
    I'm auditing a note in which the physician documents the exam of 5 elements of the screening criteria for screening pelvic exam. Since 7 are required to bill G0101, would anyone suggest billing G0101-52? Is there another option for billing this physician service?
    Jenny Berkshire, CPC, CEMC, CGIC

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Did he examine the breast also?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Location
    Kansas City, MO
    Posts
    751
    Default
    Modifier -52 is not a valid modifier for G0101. If 7 of the 11 elements aren't documented, then you don't have a billable service based on the G0101 guidelines.
    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

  4. #4
    Default
    No, he did not examine the breasts. Why isn't 52 modifier appropriate? Is that anywhere in the regs? I couldn't find anything in the Medicare Carriers' Manual. I hate to see physicians provide services and not be able to bill for them.
    Jenny Berkshire, CPC, CEMC, CGIC

  5. #5
    Location
    Kansas City, MO
    Posts
    751
    Default
    I might have spoken to soon. My carrier is WPS and they do not allow -52 on any E/M service and G0101 is considered the covered portion of a preventive E/M service. Now, your carrier may be different.
    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

  6. #6
    Default
    You're right, Angela. My carrier, Palmetto, indicates the 52 modifier cannot be used for E&M services. Thanks for the insight. (I still hate to give up on billing a physician service.)
    Jenny Berkshire, CPC, CEMC, CGIC

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