Wiki Awv

[kathleenl]

Hi,

I have a situation where a Medicare patient comes in for her annual GYN visit, it is billed out as G0101 and is denied because she had one a year ago, and is she is not high risk so she should be coming in bi-annually. I am being directed to use G0439 instead. The note is documented as a well woman visit - no complaints, no meds or tests ordered. Basically - all is well. I would prefer to educated the physician on the Medicare guidelines re screening pelvic/pap exams.
I do not think using G0439 is correct. Has anyone else come across this or have any suggestions?

Thank you in advance.

Kathleen

 

[Anastasia]

In the absence of high-risk diagnoses, you can't bill yearly for a Medicare preventive. Was an ABN signed by the patient?

 

[mitchellde]

In the absence of high-risk diagnoses, you can't bill yearly for a Medicare preventive. Was an ABN signed by the patient?

You cannot charge a well woman as a yearly when the documentation can only support the well woman . You also do not need an ABN since Medicare tells the beneficiary that a well woman is covered only biannual. You will bill the student for this.