August 2008 News

  

“Changes to the Medicare Well Woman Exam”  According to CMS Transmittal 1541, when a physician performs a screening pelvic examination (with our without specimen collection for pap smears and cultures, which include a clinical breast examination), the exam has to include at least seven of the following eleven elements. 1.       Inspection and palpation of breasts for masses, lumps, symmetry, or nipple discharge or tenderness 2.       External genitalia 3.       Urethral meatus 4.       Digital rectal examination 5.       Urethra 6.       Bladder 7.       Vagina 8.       Cervix 9.       Uterus 10.    Adnexa/parametria 11.    Anus and perineum The breast exam does not have to be one of the seven elements in the above list. CMS previously listed the bulleted elements, which suggested that the physician was required to perform a breast exam. The definition for code G0101 includes a clinical breast exam. CMS’s Transmittal 1541 clearly defines the requirements and it is appropriate to report G0101 even when the physician does not perform a breast exam.  If the physician performs a complete well-woman exam (pelvic/breast exam, Pap smear) for a Medicare patient report codes G0101 and Q0091. The appropriate diagnosis code(s) are:     V76.2 – special screening for malignant neoplasm’s, cervix (low risk)   V15.89 - other specified personal history presenting hazards to health, others - when the patient has not been seen in 7 years without a pap smear. Example: Medicare patient presents to the physician office and request a Pap smear only.   Report: Report CPT Q0091 with diagnosis code V76.2. If a repeat pap smear is performed be sure to append modifier 76. It is a good rule to ensure that ABN’s are being obtained if the physician performs a pap smear sooner than the limitations allow. If you need any additional information on this article or Coding & Compliance services, please contact Cindy Tipton at Cindy_Tipton@MED3000.com For a printable version, click:  CCNewsletterAugust2008   Click here, if you would like to subscribe to this monthly MED3OOO e-communication newsletter.    ©Copyright 2008. MED3000 Group, Inc. All Rights Reserved