Wiki OBGYN Medicare Preventative visit to replace with regular office visit E/M?

[scrawford1690@gmail.com]

Hey everyone,

I have several doctors coding a 99213 for Medicare patients, since the preventative code does not pay. Patient has no complaints, only coming in for the annual... This does not seem right to me. They do breast/pelvic exam so I'm charging the G0101. In my opinion I should ONLY be charging the G0101 for payment and the 9939(x) with an ABN modifier.

Am I right? Or can the doctor charge the 99213?

 

[csperoni]

Let's reword your question.
Can the provider code for a service that was not provided, in order to receive payment? That seems like an obvious "nope".
If the provider is also collecting PAP, you can bill for the Q0091 as well as G0101.
Only if the provider evaluated and treated a problem should you bill a problem oriented E&M service.

 

[scrawford1690@gmail.com]

Let's reword your question.
Can the provider code for a service that was not provided, in order to receive payment? That seems like an obvious "nope".
If the provider is also collecting PAP, you can bill for the Q0091 as well as G0101.
Only if the provider evaluated and treated a problem should you bill a problem oriented E&M service.

Thanks so much! That's exactly what I thought, but rewording it like that is a great way to explain it to the doctors.

Do you perhaps know if the G0101 is billable to Medicaid also?

 

[csperoni]

I believe each state Medicaid makes their own decision regarding G0101. My state's Medicaid permits 9938x-9939x for preventive, so that is what we bill.