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Breast Exam

  1. #1
    Default Breast Exam
    Medical Coding Books
    I work for a family practice and we had a Medicare patient come in for a suspected breast mass. The doctor did a breast exam and per the Medicare website, the patient is eligible for G0101. He sent her for an ultra sound. Should I use G0101 with V76.19 for screening? She hasn't had a breast exam in 4 years. Any thoughts would be appreciated.

  2. #2
    Evansville Indiana
    Default G0101
    G0101 is for screening pelvic exam, which includes a screening breast exam. It sounds to me like this was a problem visit and should be billed with the appropriate E&M code. Regardless, even if this was a screening breast exam, without the appropriate elements of the pelvic exam you could not bill the G0101.

  3. Default
    I would use the V76.19, but you can't charge for a breast exam, only the E&M.

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