Include non-screening pelvic exam in E/M criteria
APCs Weekly Monitor, June 9, 2006
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Include non-screening pelvic exam in E/M criteria
QUESTION: A patient presents to the ED with a complaint that requires a manual pelvic exam without anesthesia. Should this be coded separately or would it be included in the E/M code?
ANSWER: There is no separate CPT code for a non-screening pelvic exam. Therefore, include the resources involved in a diagnostic pelvic exam in your hospital's ED E/M guidelines for one of the five E/M facility levels (99281-99285).
However, be aware of code G0101 "Cervical or vaginal cancer screening; pelvic and clinical breast examination." Report this code for a screening pelvic exam. G0101 falls under APC 0600, which has a payment rate of $52.37.
This code has a status indictor V, meaning a visit for which payment is allowed under the hospital OPPS. According to the HCPCS 2006 Manual, you can report G0101 with an E/M code when a separately identifiable E/M service was provided.
Note that it is highly unusual for an ED patient to receive a screening pelvic exam. Be sure to include the non-screening pelvic exam as a component of your hospital's ED E/M facility guidelines.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Related Products
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Topic: CMS, OESS post new security compliance review information, checklist
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- QA:Coding multiple initial infusions
- News and briefs: Oklahoma Osteopathic Association against residency bill change
- HIPAA Q&A: Level of encryption needed for email
- OB services: Coding inside and outside of the package
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- CMS has reformulated payments for some bilateral procedures
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- What does case-mix index mean to you?
- Identify modifiable risk factors to prevent patient falls
- Hospitals are not bound by InterQual criteria for determining patient status
- Searched