Wiki Preventitive Visit-Medicare Pt w/other problems


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We are trying to make sure that we are coding visits correctly when a medicare patient comes in for an annual well woman exam along with annual followup on her chronic or ongoing medical conditions (diabetes, hypertension, hyperlipidemia). We have been told a couple of different ways to do it and would like to make sure that we are doing this the CORRECT way. Please let us know.
If the patient is being seen for preventive medicine, you should report the age appropriate code. Only if there is both a breast and pelvic exam can you report HCPCS code G0101. If a screening pap is obtained, code Q0091. IF there is significant enough extra work involved above and beyond the PE, then the appropriate level E/M code may be reported with modifier -25. In this scenario, you have to subtract the medicare fee for the G0101, Q0091, and E/M from your regular fee for the preventive medicine exam. The total charge for that date of service should not be higher than your regular fee for the preventive medicine code (i.e. if your 99397 charge is $250, you can't charge MORE than that). Medicare will cover the E/M, Q, and G as appropriate (minus deductible, 20%). The patient responsibility will be the difference between the PE and the other codes, in addition to their deductlble and 20%. Make sure you check your ICD-9 coding. Does that make sense? And PLEASE if anyone disagrees let me know! Oh - and it's a GREAT idea to have TWO separate notes!
Hey Lisa - That is how we understand to bill it also so we were just wanted to be sure we were doing it right. We know that if there are NO other medical problems, then we bill it as a preventive medicine code for the appropriate age. We just wanted to be sure when there were other medical issues that we were billing it out the right way. Thanks for your input. Donna