Wiki Medicare Well-Woman question

[colebk]

Hi all - One of our providers just returned from a billing conference-type meeting. I would just appreciate some clarity regarding MCR well-woman visits. We see a fair few for their breast/pelvic exams and now we are being told to bill these differently. Anyone with more knowledge or experience, it would be greatly appreciated. In the past, we would have an ABN signed for G0101 and Q0091 if a Pap was obtained. Can someone give me a simple example of how to bill a straight MCR well-woman visit with breast/pelvic exam? I'm so confused. /:

 

[nielynco]

Hi all - One of our providers just returned from a billing conference-type meeting. I would just appreciate some clarity regarding MCR well-woman visits. We see a fair few for their breast/pelvic exams and now we are being told to bill these differently. Anyone with more knowledge or experience, it would be greatly appreciated. In the past, we would have an ABN signed for G0101 and Q0091 if a Pap was obtained. Can someone give me a simple example of how to bill a straight MCR well-woman visit with breast/pelvic exam? I'm so confused. /:

How are you being told to bill for them? If the patient is Medicare and is presenting for her annual exam, you cannot bill a preventive service to Medicare for this. You will have to bill the patient for the non-covered portion of the visit and bill Medicare G0101 and Q0091 in the covered year. If it is a non-covered year, she signs an ABN and you bill her for the full preventive service. Many years ago I prepared the attached document for my clients. The information is accurate except that I have not updated the ICD-10-CM diagnosis codes in the document.

 

[colebk]

How are you being told to bill for them? If the patient is Medicare and is presenting for her annual exam, you cannot bill a preventive service to Medicare for this. You will have to bill the patient for the non-covered portion of the visit and bill Medicare G0101 and Q0091 in the covered year. If it is a non-covered year, she signs an ABN and you bill her for the full preventive service. Many years ago I prepared the attached document for my clients. The information is accurate except that I have not updated the ICD-10-CM diagnosis codes in the document.

That is an awesome document and I cannot thank you enough. Currently, we're a small GYN practice and we bill the G0101 +/- Q0091 every 2 yrs, but will typically refills meds or something small as a "courtesy" and if they need to be seen later for any issues, that gets billed E/M. Someone new wants us to bill anything above/beyond breast/pelvic/Pap as the 9939X to get the denial plus G0101 for breast/pelvic exam. There is some fear of losing our long-established patient population (we don't have a ton). It's just a sticky situation, I guess.

 

[nielynco]

That is an awesome document and I cannot thank you enough. Currently, we're a small GYN practice and we bill the G0101 +/- Q0091 every 2 yrs, but will typically refills meds or something small as a "courtesy" and if they need to be seen later for any issues, that gets billed E/M. Someone new wants us to bill anything above/beyond breast/pelvic/Pap as the 9939X to get the denial plus G0101 for breast/pelvic exam. There is some fear of losing our long-established patient population (we don't have a ton). It's just a sticky situation, I guess.

But should be handled with patient education by explaining before they get the service how it will be billed. Maybe have a special pamphlet available for them. I know Medicare does have these resources for their patient population on Medicare.com. The following document is published for patients and includes the breast/pelvic exam and welcome to Medicare exam explanations: https://www.medicare.gov/publications/10110-Your-Guide-to-Medicare-Preventive-Services.pdf

 

[colebk]

Yes, those are great ideas. We just have 3 providers and they all want things done differently. :|. I printed off the document you provided for their review - it was extremely helpful!