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Thread: G0101

  1. #1
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire

    Default G0101

    AAPC: Back to School
    I was wondering if anyone has the link to the requirements that are to be met to use this code? Thanks in advance.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Join Date
    Apr 2007
    Columbus GA

    Smile G0101

  3. #3
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire


    This is exactly what I was looking for and then some.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4


    Here is a link that might be helpful.

    Also here is what I use as guidelines:

    Medicare covers a screening breast and pelvic exam once every two years. In order for this service to be paid the provider's exam must include at least seven elements, which are shown below.

    G0101=669202 Breast and pelvic exam

    Q0091=99004 is Obtaining, preparing and conveyance of the cervical or vaginal smear to the lab

    Diagnosis Codes:
    V76.2-Cervix (routine Cervical Pap smear)
    V76.47-Special screening for malignant neoplasm, vagina
    V76.49-Special screening for malignant neoplasm, other sites
    V76.49- for a patient without a uterus or cervix
    V15.89- high risk-indications listed below
    for cervical cancer: early onset of sexual activity (under 16 years);
    multiple sex partners (5 or more per lifetime); history of STD; fewer than 3 negative Pap smears within the previous 7 years
    for vaginal cancer: exposed daughters of women who took DES during pregnancy

    Required Documentation
    In order for the screening breast and pelvic examination to be covered by MEDICARE, the provider's exam must include at least seven (7) of the following eleven (11) elements:
    1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge
    2. Digital rectal exam including sphincter tone, presence of hemorrhoids, and rectal masses
    Pelvic exam (with or w/o specimen collection for smears and cultures) including:
    3. External genitalia (e.g., general appearance, hair distribution, or lesions)
    4. Urethral meatus (e.g., size, location, lesions, or prolapse)
    5. Urethra (e.g., masses, tenderness, or scarring)
    6. Bladder (e.g., fullness, masses, or tenderness)
    7. Vagina (e.g., general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele)
    8. Cervix (e.g., general appearance, lesions, or discharge)
    9. Uterus (e.g., size, contour, position, mobility, tenderness, consistency, descent, or support)
    10. Adnexa/parametria (e.g., masses, tenderness, organomegaly, or nodularity)
    11. Anus and perineum

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