Wiki Medicare

[jacksonnakesha]

Ob/Gyne office, we have Medicare patients that come in for annual visits. Medicare only covers the annual visit every two years. We did have the patient sign the ABN form. We billed G0101-GA without the Q0091-GA to reflect that it is just a cancer screening with diagnosis code of Z01.419. Medicare denied the claim for maximum benefits. Has anyone ever billed for this service and was reimbursed?

 

[SDELOSSANTOS1]

yes, some Medicare patients are considered high risk and will allow an WWE every year; I use the DX code Z91.89.

 

[CBLENNIE]

Per the CMS IOM 100-04 Chapter 18 Preventive and Screening Services manual sections 30.1 & 30.2 high risk patients can have a screening pap smear every 12 months. The manual lists what the indications are for being considered a high-risk individual as well as a table of ICD-10 codes to be used for high-risk patients.