Denial g0101+q0091 w/99396-25

Pillow1

Guru
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Melbourne, Florida
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Blue cross denied pymt :
Denial: Included in other service per bc ..
Cpt go101 icd 9 v72.31
and
cpt q0091 icd 9 v72.31
considered inclusive to
cpt 99396 modifier - 25
icd9 272.4
401.9
250.00
296.90

is there another way to bill this ?

Thanks for all of your feedback :)
 

bonzaibex

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Local Chapter Officer
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Engelwood, CO
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Most non-Medicare carriers consider the G0101 & Q0091 to be included in the preventive exam code. Our area Blue Cross provider (Anthem) released a written policy early last year, I believe, specifically bundling those codes into the preventive exam. Considering the G & Q codes were created by Medicare in order to separate those services that Medicare covers from the parts of the physical exam that Medicare used to not cover, it makes sense that other insurance carriers would consider them to be part of the whole preventive exam.

Hope that info helps!

Becky, CPC
 

dan528i

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Hey, I had the same issues a few years back and this is what i came to:

99395-96-97 Preventative codes (including 99385-86-87) and etc. INCLUDE G0101 and Q0091.
From what i have learned G0101 and Q0091 are to be used for carriers that do not cover preventative care.
Also, If I m not mistaken but Q0091 includes G0101 because by definition its a pelvic Ca screening and collection of PAP. This part I am not too sure.
However, all Preventative codes (99385-6-7 99395-6-7) Include PapQ0091 and breast examG0101. So i don't think it would be correct to bill 99385-25 and Q0091 and G0101.
Hope this helps. good luck.
 

dan528i

Guest
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91
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Blue cross denied pymt :
Denial: Included in other service per bc ..
Cpt go101 icd 9 v72.31
and
cpt q0091 icd 9 v72.31
considered inclusive to
cpt 99396 modifier - 25
icd9 272.4
401.9
250.00
296.90

is there another way to bill this ?

Thanks for all of your feedback :)
Almost, forgot here is how i would code this:
99396 with V72.31 ONLY
and then 99213-25 or 99214-25 (follow guidelines for correct E/M) with Dx
272.4
401.9
250.00
296.90

And I m pretty sure you can only have a Total of 4 CPTs on a claim so ....
Your B/X Should pay on both CPTs and if they dont send an appeal w/ copy of CPT guidelines (from a book) where it sates that "2 office visits are allowed on same DOS".

GOOD LUCK
 

mitchellde

True Blue
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13,404
Location
Columbia, MO
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1
If this is a preventive encounter then there is no reason for the ov. Just because a patient has chronic issues, to discuss these issue and order tests or renew med is all part of the preventive. While the dx codes may be listed in addition to the preventive dx code you cannot just charge an ov in addition. If the patient has a new symtomatic issue that is discussed or investigated at the same time as the preventive then you may charge an ov. But if the patient requested and presented for a preventive only then you have no reason to charge an ov charge.
 
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