Ask Joan: How to code when only a breast exam – no pelvic – is performed

Why This Topic Matters

Breast screening services can be billed differently depending on payer type and the overall encounter context. Understanding the article helps practices avoid using inappropriate preventive or problem-oriented reporting approaches for this type of visit.

Article Sections

1. Question

   A reader asks about reporting a breast-only screening exam for an older woman, including whether an E/M service would be appropriate and what diagnosis coding considerations may apply.

2. Answer

   Guidance is provided for non-Medicare and Medicare contexts, including discussion of HCPCS Level II reporting, payer acceptance, and the broader encounter setting for the screening service.

3. Official resources

   The article lists external CMS resources related to HCPCS code information and the application process for requesting new codes.