Medical Billing Forum

Coding => Coding => Topic started by: djk on April 04, 2014, 01:48:26 PM

Title: Coding for breast exam only
Post by: djk on April 04, 2014, 01:48:26 PM
I have been using the G0101 with V72.31 and V72.10 but Medicare doesnt like this any suggestions ??? ???
Title: Re: Coding for breast exam only
Post by: Merry on April 04, 2014, 09:00:00 PM
There is no code for a breast exam only.  You can bill the appropriate E/M code for the visit.  For example.. Woman found mass on self exam.  Be sure to use correct dx.  Let us know please if this is not the correct scenario.
Title: Re: Coding for breast exam only
Post by: djk on April 07, 2014, 07:55:49 AM
it is just part of there annual exam..
Title: Re: Coding for breast exam only
Post by: Michele on April 07, 2014, 09:01:09 AM
G0101 is for a pelvic exam.  Isn't the breast exam part of the annual exam?  I've never seen it coded separately.
Title: Re: Coding for breast exam only
Post by: djk on April 07, 2014, 09:19:42 AM
The G101 is for pelvic and breast exam according the code book, but when i bill the Dx V76.10 and V76.19 for breast screening I get denial for invalid DX.
Title: Re: Coding for breast exam only
Post by: HeidiK on April 08, 2014, 02:42:27 PM
Hello!

G0101 is defined as: Cervical or vaginal cancer screening; pelvic and clinical breast examination so using V76.10 and V76.19 is most likely causing your invalid diagnosis denial.

A screening is a preventative measure to identify potential malignancies as well as other potential issues.  The V76 block of diagnosis codes falls under "Special screening for malignant neoplasms" so using the two together is contradictory. 

In addition, G0101 includes both pelvic and breast exam so only using a "breast exam" diagnosis code causes the rejection.  For example, you couldn't code for a pelvic x-ray with a diagnosis relating to the breast.

Hope this helps a bit!
Title: Re: Coding for breast exam
Post by: djk on April 28, 2014, 08:04:20 AM
Can you bill for an E/M with the GYN exam  G0101
Title: Re: Coding for breast exam only
Post by: Michele on April 28, 2014, 12:16:00 PM
Can't really answer that without more info.  What would be the dx for the E/M?  Is it significantly separate and identifiable from the G0101?  Was there more done than the pelvic exam and for another reason?  The chart must also support the codes billed.
Title: Re: Coding for breast exam only
Post by: djk on April 29, 2014, 12:19:16 PM
no, just a breast and pelvic exam no pap
Title: Re: Coding for breast exam
Post by: djk on May 01, 2014, 07:47:50 AM
The E/M is for problem focus only, so if a patient comes in just for GYN annual exam, had a pap a year ago so you can't bill for a pap this year, would you just bill for G0101 with DX V76.10 can you use V72.31 for gyn exam