medicare charges

kimb

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Please Help clear up some charges for medicare. Pt are allowed one Welcome to Medicare Physical which is code with dx. V70.0 (correct or not)

We are also having problems between G0101 & Q0091 When do you use these codes and which dx do you use V72.31 or V76.2

I am understanding that V76.2 is for pap only and v72.31 is for exam with or without pap.

Please Help
 

Kiana

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This is my knowledge: If you're billing the E&M with G0101 & Q0091 don't forget you can add your -25 modifier to your E&M. Effective 1.1.05 Medicare Part B allowed beneficiaries a one-time welcome visit within the first 6 months and will pay for a one-time ultrasound screening for the Abdominal Aortic Aneurysm (AAA). There are other exam components that Medicare covers for screening, but V72.31 is used for low risk beneficiaries for your pap and pelvic exams and only used when a full gyn exam is performed.
Other low risk dx includes: V76.2, V76.47, V76.49 for women w/out a cervix.
High risk dx would be V15.89.

The Welcome to Medicare visit is a comprehensive exam w/ 7 components:
1. A review of an individual's medical and social history w/ attention to modifable risk factors
2. A review of an individual's potential risk factors for depression
3. A review of the individual's functional ability and level of safety
4. An examination to include an individual's height, weight, blood pressure, and visual acuity
5. Performance and interpretation of an EKG
6. Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components
7. Education, counseling, and referral, including a brief written plan such as a checklist for obtaining the appropriate screening and/or other Medicare Part B preventative services

The V70.0 is for routine general medical exam, nothing is wrong with the patient. If the welcome visit is considered comprehensive there should be other dx available.

I hope this helps.
 
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