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tci E/M Coding Alert - 2023 Issue Q2

Specialty Focus: Use This Carve Out Rule Knowledge

 Hint: A modifier can show Medicare that you know the service isn’t covered. Medicare’s rules concerning gynecological care can be confusing. If a Medicare beneficiary comes into your practice for a preventive service that might be an evaluation and management (E/M) service — but isn’t covered under the definition or timing requirements of HCPCS code G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) — do you know how to calculate the patient’s fee? Do you know how to calculate the patient’s fee using the “carve out” rule? Find out...

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