Routine GYN exam - but not annual PE - to Medicare/secondary payer ??

bnockis

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Hi!

I will try to explain a scenario without being totally confusing. I am fairly new to this facility and coding in general. I am the only coder with no one else to refer to, so I really need help!

So what IF a patient has Medicare and another insurance (Medicaid, CDPHP, BSNENY.. take your pick - most of our patient have a secondary). We perform, what the providers consider, a routine GYN exam. It is not the same as their yearly physical. it contains components of a PE; HPI, ROS, histories, risk factors, vitals, fairly detailed PE, breast/pelvic exam, Pap, Med review, urinalysis, --> A&P with z01.419, etc etc. I was told it was billed as a 9939x with a GY on the 9939x. Medicare will generally pick up any other services (urinalysis) and roll the balance of 9939x to the next payer, who will normally reimburse without issue. (I am also under the impression that, and it seems to have not been an issue, we can bill two comprehensive preventive medicine codes per year, as long as one is for GYN/Well woman services.

Is this being billed incorrectly? I have come across some info, incidentally while looking for other answers, and am unsure if we are supposed to also bill G0101-GA and Q0091-GA? With the GY still on the 9939x so that Medicare will carve out the G and Q services and roll the rest of the 9939x to the next payer.

Obviously, we want to make sure we are getting appropriate reimbursement for services performed, but I also want to make sure it's 100% from me as I pass it along to billing.

Thank you so much in advance for any help you can give!

Lindsay B., CPC-A
 
Medicare Well-woman exam

Hi. I hope I can help. It is appropriate to bill the 9939X code with the GY modifier making the patient responsible for the preventive examination that is not covered by Medicare. However, the Pap collection and breast/pelvic exams are covered by Medicare and must be reported with appropriate HCPCS codes. The American College of Obstetricians and Gynecologists (ACOG) provides a great resource for understanding how to bill and carve out the portion that the patient will pay. https://www.acog.org/About-ACOG/ACOG-Departments/Coding Particularly, see example three on page 5.
Best wishes,
Cindy


Hi!

I will try to explain a scenario without being totally confusing. I am fairly new to this facility and coding in general. I am the only coder with no one else to refer to, so I really need help!

So what IF a patient has Medicare and another insurance (Medicaid, CDPHP, BSNENY.. take your pick - most of our patient have a secondary). We perform, what the providers consider, a routine GYN exam. It is not the same as their yearly physical. it contains components of a PE; HPI, ROS, histories, risk factors, vitals, fairly detailed PE, breast/pelvic exam, Pap, Med review, urinalysis, --> A&P with z01.419, etc etc. I was told it was billed as a 9939x with a GY on the 9939x. Medicare will generally pick up any other services (urinalysis) and roll the balance of 9939x to the next payer, who will normally reimburse without issue. (I am also under the impression that, and it seems to have not been an issue, we can bill two comprehensive preventive medicine codes per year, as long as one is for GYN/Well woman services.

Is this being billed incorrectly? I have come across some info, incidentally while looking for other answers, and am unsure if we are supposed to also bill G0101-GA and Q0091-GA? With the GY still on the 9939x so that Medicare will carve out the G and Q services and roll the rest of the 9939x to the next payer.

Obviously, we want to make sure we are getting appropriate reimbursement for services performed, but I also want to make sure it's 100% from me as I pass it along to billing.

Thank you so much in advance for any help you can give!

Lindsay B., CPC-A
 
Thank you for the feedback! would the correct way to bill be using the GY and GA mods? When I open the link, it gives me options of articles and such. do you know which one specifically is helpful?

Thank you!
 
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