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Digital Rectal Exam

  1. #1
    Post Digital Rectal Exam
    Medical Coding Books
    My provider wants to bill for a digital rectal exam. I can't find a code so I'm inclined to think that it would be included in the office vist/E & M? Any insight/rationale would be appreciated.

    thank you,
    Susan G.

  2. #2
    North Carolina


    HCPCS code G0102 (Prostate cancer screening; digital rectal examination) is not separately payable with an evaluation and management code (CPT codes 99201-99499). CMS published this policy in the Federal Register, November 2, 1999, page 59414 as follows:

    As stated in the July 1999 proposed rule, a digital rectal exam (DRE) is a very quick and simple examination taking only a few seconds. We believe it is rarely the sole reason for a physician encounter and is usually part of an E/M encounter. In those instances when it is the only service furnished or it is furnished as part of an otherwise non-covered service, we will pay separately for code G0102. In those instances when it is furnished on the same day as a covered E/M service, we believe it is appropriate to bundle it into the payment for the covered E/M encounter.”

    Chapter 12 of the NCCI policy Manual

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