Health Information Management

Include non-screening pelvic exam in E/M criteria

APCs Insider, June 9, 2006

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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.

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