Wiki Preventive, Breast Pelvic, and Pap for Medicare Patient

[sparkles1077]

One of our coders made the point that our providers' document a preventive service plus a breast/pelvic exam (G0101) and a pap (Q0091) for Medicare patients. Her experience is that the preventive can still be billed although not payable by Medicare. If the patient has a secondary such as a Medicare Advantage Plan, they often pick up the preventive. Just wondering if others have similar experience/knowledge? From a documentation perspective, I would agree this is correct coding.

Thank you

 

[pineapplelvr]

At the clinic i work at, it's our policy to bill the preventive px with a GY mod and then reduce the price of it by subtracting the cost of the G0101 (if at least seven components were met...) and Q0091

example
99397-Gy $246.58
G0101 -78.95
Q0091 -75.71
TOTAL $91.92 for px

 

[Leenahz]

Can't say I've seen a secondary insurance pay when a charge has been disallowed by Medicare. Generally, Medicare has to allow the charge first. That said, I've seen the annual Medicare physical (G043_), pelvic exam (G0101), and Q0091 paid together.

Good luck

Marlena