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11 Documentation Elements for Medicare G0101 www.CaptureBilling.com 703.327.1800

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Page 1: 11 Documentation Elements for Medicare G0101

11 Documentation Elements for Medicare G0101

www.CaptureBilling.com703.327.1800

Page 2: 11 Documentation Elements for Medicare G0101

Document 7 of 11 Elements to Bill a Medicare Screening Pelvic Exam

I was recently asked about what needs to be documented to bill and get reimbursed for Medicare’s G0101, the Breast and Pelvic Exam that is part of the Well Woman Exam. Per the Centers for Medicare & Medicaid Services’ (CMS) document entitled, Screening Pelvic Examinations, on the Medicare Learning Network, G0101 is payable when at least 7 of the following 11 elements are included and documented in the exam.

Follow the G0101 documentation requirements listed.

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http://www.capturebilling.com/medicare-billing-well-woman-exam-g0101-q0091/
http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
Page 3: 11 Documentation Elements for Medicare G0101

Documentation Guidelines for G0101

1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge

2. Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses

3. External genitalia (for example, general appearance, hair distribution, or lesions)

4. Urethral meatus (for example, size, location, lesions, or prolapse)

5. Urethra (for example, masses, tenderness, or scarring)

6. Bladder (for example, fullness, masses, or tenderness)

www.CaptureBilling.com703.327.1800

http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
Page 4: 11 Documentation Elements for Medicare G0101

Documentation Guidelines for G0101

7. Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele)

8. Cervix (for example, general appearance, lesions or discharge)

9. Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support)

10.Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity)

11.Anus and perineum

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http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
Page 5: 11 Documentation Elements for Medicare G0101

Documentation Guidelines for G0101

The CMS material covers all the documentation elements needed: How frequently the exam can be done

Co-insurance and deductible information

Diagnosis requirements and billing instructions

The document also includes reasons that the service may be denied. This is great information if you are doing medical billing for an OBGYN, Internal Medicine, or Family

Practice.

www.CaptureBilling.com703.327.1800

http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
Page 6: 11 Documentation Elements for Medicare G0101

Documentation Guidelines for G0101

Note that even if you use Electronic Health Records (EHR), your templates may not be set up properly to capture all the data needed, so make sure you check it out.

I have yet to see an EMR set up properly out of the box.

If you are still on paper, you may want to make a template for this screening procedure to make sure you don’t forget anything.

To download the CMS Screening Pelvic Examinations August 2012 report CLICK HERE. 

Medicare requirements change all the time, so head over to the the CMS website for the most updated information on this topic.

Oh, and don’t forget to have the patient sign an Advanced Beneficiary Notice (ABN).

www.CaptureBilling.com703.327.1800

http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
http://www.capturebilling.com/wp-content/uploads/2014/01/Medicare-G0101-Screening-Pelvic-Examinations.pdf
http://www.cms.gov/
http://www.capturebilling.com/medicare-advance-beneficiary-notice-abn-a-quick-how-to/
Page 7: 11 Documentation Elements for Medicare G0101

Are you a Capture Billing client?

Need help? Hire us.

• If you are one of our clients, you already get the benefit of our help and knowledge.

• Capture Billing makes your medical billing process easy. There’s no need to learn any complicated coding or billing skills because we do it all for you, from sending claims to follow-up.

• Even if you are not a client, we provide the information in this post as a starting point for your research so you can do it yourself. Need help? Hire us.

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http://www.capturebilling.com/medical-billing-services/overview/
http://www.capturebilling.com/medical-billing-services/overview/
Page 8: 11 Documentation Elements for Medicare G0101

About the Author:

Manny Oliverez

Manny Oliverez, CPC, is a 20-year healthcare veteran and the CEO and co-founder of Capture Billing, a medical billing services company located outside of Washington, D.C. He teaches the nation’s physicians, administrators, and medical practices how to maximize billing and revenue cycle management processes. Manny also frequently posts articles and videos on his award-winning healthcare blog. For more information on Manny and his company, please visit his website, or call (703)327-1800. And if you’re on LinkedIn, please look for him there too.  READ MORE

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