tracylc10
Guest
Coding annual exams for Medicare... Cringe!!
This is what I think I understand...
G0101-GA, Q0091-GA and appropriate preventive med code with modifier GY and 52. You would "carve out" the cost of G0101 and Q0091 and what is left over would be the patients responsibility. (This is if there is a ABN signed)
If the patient is also seen for a problem, would you add the problem E&M code and drop the preventive code or just add the problem E&M?
G0101-GA, Q0091-GA, Preventive code-GY-52 and 99213-25
Or
G0101-GA, Q0091-GA and 99213-25?
From what I am reading in the COBGC study guide, it states:
"Because Medicare will cover the breast/pelvic exam and Pap smear collection for eligible patients but not the comprehensive exam, you much "carve out" the fee for the pelvic/breast exam and Pap smear collection from the usual fee you charge the patient for the comprehensive exam. In other words, the charge for G0101 and Q0091 must be deducted from the usual charge for the preventive service.
Although not covered by Medicare, you must nevertheless report the appropriate preventive care code (99385-99387 or 99395-99397) with modifier GY.
Medicare similarly will cover a medically necessary sick patient visit provided at the same time as a preventive service.
Once again, you will want to be sure to attach a 25 modifier to the appropriate E/M service code billed on the same day as other services. As well you should "carve out" the covered sick visit from the total charge that includes the same-day preventive services. You would subtract the established fee for the covered problem service from the established fee for the non-covered service. You will then bill the patient the deductible/copay for the covered service, plus the cost of the non-covered service."
If there is anyone out there that understands all of this and can explain it in a way that makes complete sense, I would really appreciate your help.
Thank you in advance for taking the time to read this long message.
Tracy
This is what I think I understand...
G0101-GA, Q0091-GA and appropriate preventive med code with modifier GY and 52. You would "carve out" the cost of G0101 and Q0091 and what is left over would be the patients responsibility. (This is if there is a ABN signed)
If the patient is also seen for a problem, would you add the problem E&M code and drop the preventive code or just add the problem E&M?
G0101-GA, Q0091-GA, Preventive code-GY-52 and 99213-25
Or
G0101-GA, Q0091-GA and 99213-25?
From what I am reading in the COBGC study guide, it states:
"Because Medicare will cover the breast/pelvic exam and Pap smear collection for eligible patients but not the comprehensive exam, you much "carve out" the fee for the pelvic/breast exam and Pap smear collection from the usual fee you charge the patient for the comprehensive exam. In other words, the charge for G0101 and Q0091 must be deducted from the usual charge for the preventive service.
Although not covered by Medicare, you must nevertheless report the appropriate preventive care code (99385-99387 or 99395-99397) with modifier GY.
Medicare similarly will cover a medically necessary sick patient visit provided at the same time as a preventive service.
Once again, you will want to be sure to attach a 25 modifier to the appropriate E/M service code billed on the same day as other services. As well you should "carve out" the covered sick visit from the total charge that includes the same-day preventive services. You would subtract the established fee for the covered problem service from the established fee for the non-covered service. You will then bill the patient the deductible/copay for the covered service, plus the cost of the non-covered service."
If there is anyone out there that understands all of this and can explain it in a way that makes complete sense, I would really appreciate your help.
Thank you in advance for taking the time to read this long message.
Tracy
