Preventive visit with G0101 and Q0091 (denial)

ollielooya

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List, just getting started in this particular type of coding and a commercial insurance was billed:
99213-25 (578.1) (611.71)
99395 (V70.0)
G0101 V(70.0)
Q0091 (V76.47)
All Lines processed/paid except for the G0101 with Remark code "please submit corrected claim with correct cpt coding" What needs to be corrected?

Are additional modifiers needed in this case? Will the G0101 bundle into the 99395? I notice that the dx code for V76.47 requests additional code, which doctor didn't provide and that particular line item processed ok. Does the V70.0 code for the G0101 need to be sent back to the doctor for evaluation? Will this code pay?
As always any and all input is appreciated. Will check out the CPT Assistant Archives for guidance while awaiting an answer.

Suzanne E. Byrum CPC
 

ollielooya

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Ah, Deborah, was hoping you'd make an appearance. THANK YOU so much! So other than that, good to go without any additional modifiers? ---Suzanne
 

mitchellde

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LOL it is my day off so I am catching up! I would include the V88 code as well but other than that I see no issue. Of course assuming the documentation supports everything! :)
 

ollielooya

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Deborah and others, (pressing the matter a little more), so the G0101 should link to V72.31 which requires either the V73.81 or V76.47. Then from there we are instructed to use a code from the V88 category, so actually 3 V-codes will be linked to the G0101? (provind the documentation supports everything!)

And since the doctor also used V76.47 for the G0091 code it would need a code from the V88 category as well? Please tell me I’m “getting it”.

It’s time to quit for the day.
--Suzanne
 

kathy a

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I just dont understand how you can bill a level 3 office visit, a preventative and a medicare preventative visit and get paid for all three. If we have a patient having an annual visit:

Medicare is G0101, Q0091 and G0328-if there is a hemmocult done.
Commercial Ins- is the preventative for their age ie # 99396 and Q0091 for some commercial insurances.

How are you billing out for three types of visits and getting paid for all three. This I am not getting. I am rather new to OB/GYN coding , but have never heard of this. I am from Pennsylvania.

Thanks, Kathy Albert,CPC
 

mjb5019

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3 types of visits

Medicare only pays Welcome to Medicare physicals and the newish AWV so I doubt if the PX code will pay.
 
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