Pelvic Examination CPT code G0101

A screening pelvic examination is an important part of preventive health care for all adult women. A pelvic examination is performed to help detect pre-cancers, genital cancers, infections, sexually transmitted diseases (STDs), other reproductive system abnormalities, and genital and vaginal problems. STDs in women may be associated with cervical cancer. In particular, one STD, human papillomavirus (HPV), causes genital warts, and cervical and other genital cancers.

The pelvic examination is also used to help find fibroids or ovarian cancers, as well as to evaluate the size and position of a woman’s pelvic organs. In addition, a Medicare screening pelvic examination includes a breast
examination, which can be used as a tool for detecting, preventing, and treating breast masses, lumps, and breast cancer. The screening pelvic examination benefit covered by Medicare can help beneficiaries maintain the general overall health of their lower genitourinary tract.

Coverage Information

Medicare provides coverage of a screening pelvic examination for all female beneficiaries when performed by a doctor of medicine or osteopathy, or by a certified nurse midwife, physician assistant, nurse practitioner, or clinical nurse specialist who is authorized under State law to perform the examination (this examination does not have to be ordered by a physician or other authorized practitioner). Frequency of coverage is provided as follows:

Covered once every 12 months:
Medicare provides coverage of a screening pelvic examination annually (i.e., at least 11 months have
passed following the month in which the last Medicare-covered pelvic examination was performed) for
beneficiaries that meet one (or both) of the following criteria:

* There is evidence that the woman is in one of the high risk categories (previously identified) for developing cervical or vaginal cancer, has other specified personal history presenting hazards to health, and at least 11 months have passed following the month that the last covered screening pelvic examination was performed.

* A woman of childbearing age had an examination that indicated the presence of cervical or vaginal
cancer or other abnormality during the preceding 3 years.

Covered once every 24 months:

Medicare provides coverage of a screening pelvic examination for all asymptomatic female beneficiaries every 2 years (i.e., at least 23 months have passed following the month in which the last Medicare-covered pelvic examination was performed).

Procedure Codes and Diagnosis Information.

G0101
Cervical or vaginal cancer screening; pelvic and clinical breast examination

V72.31
Routine Gynecological Examination
NOTE: This diagnosis should only be used when the provider performs a full gynecological examination.
V76.2
Special screening for malignant neoplasms, cervix
V76.47
Special screening for malignant neoplasms, vagina
V76.49
Special screening for malignant neoplasms, other sites
NOTE: Providers use this diagnosis for women without a cervix.

Coding Tips
A screening pelvic examination and a screening Pap test can be performed during the same encounter. When this happens, both procedure codes should be shown as separate line items on the claim.

The same physician may report a covered Evaluation and Management (E/M) visit and code Q0091 for the same date of service if the E/M visit is for a separately identifiable service. In this case, modifier -25 must be reported with the E/M service and the medical records must clearly document the E/M service reported. Both procedure codes should be shown as separate line items on the claim. These services can also be performed separately during separate office visits.

3 comments:

Anonymous said...

Good post and Smart Blog
Thanks for your good information and i hope to subscribe and visit my blog STD Symptoms and more Scabies Home Remedies thanks again admin

Anonymous said...

Good post and Smart Blog
Thanks for your good information and i hope to subscribe and visit my blog STD Symptoms and more Scabies Home Remedies thanks again admin

Nancy Kathlene said...

There are several medicines that can be applied directly to genital warts, depending on where they are located. Some prescription genital warts treatments can be used at home. Other treatments must be applied by your health care provider.genital warts treatment

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