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Coding for breast exam only

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HeidiK:
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!

djk:
Can you bill for an E/M with the GYN exam  G0101

Michele:
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.

djk:
no, just a breast and pelvic exam no pap

djk:
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

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