Question

If a non-Medicare patient has an age and gender appropriate preventive medicine exam (i.e., a breast and pelvic exam) this is coded with the age appropriate Preventive Medicine codes from the E/M chapter of CPT®. If a Medicare patient has a breast and pelvic exam, how is this coded?

Answer 1

When coding preventive medicine exams for Medicare patients, providers use Healthcare Common Procedure Coding System (HCPCS) codes, such as G0101 for a cervical or vaginal cancer screening exam, and G0438 or G0439 for Annual Wellness Visits.

Step-by-step explanation:

If a non-Medicare patient has an age and gender appropriate preventive medicine exam (such as a breast and pelvic exam), it is typically coded using the age-appropriate Preventive Medicine codes from the Evaluation and Management (E/M) chapter of the Current Procedural Terminology (CPT®). However, when a Medicare patient receives a breast and pelvic exam, different coding guidelines are followed. Medicare utilizes the Healthcare Common Procedure Coding System (HCPCS) for these services. For a preventive medicine exam on a Medicare patient, providers often use G codes, such as G0101 for the cervical or vaginal cancer screening (pelvic and breast examination), and G0438 or G0439 for the Annual Wellness Visit which may include a preventive physical exam. It is important for health care providers to be familiar with the Medicare guidelines to ensure the correct coding and billing for services rendered to Medicare patients.