Question S0612 vs Q0091(Gynecology/pap smear code)

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Suwanee, GA
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I am working at family medicine. we are doing for female patient Gynecology preventative exam.
For S0612 is for private( commercial) insurer and Medicaid while Q0091 is for Medicare pt.
1. Medicare pt got denied in Q code. (Medicare of GA)
2. Medicaid Advantage pt got denied in S code (Care source Market Place) so that we rebill to switch S -> Q0091 and still processing.

Any advice will be very appreciated. Thanks.
 

csperoni

True Blue
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Selden
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I usually bill gynonc, not well woman, but I may be able to provide some advice.
1. Q0091 is specifically for the PAP collection, not for the pelvic/breast or a complete preventative exam. Medicare created the code, but a few private payors will also pay for it.
G0101 is for Medicare for a pelvic and breast exam. Why did Medicare deny this? Was it bundled with another service? Was it too soon?
2. S0612 I have never even heard of this code and needed to look it up. Ob/gyns performing a well-woman exam will typically provide and bill for a preventative exam 99384-99397. Again, what was the reason for the denial?

S0612 and Q0091 do not seem interchangeable. The codes describe different services.
 

dbolivar1

Networker
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Albuquerque, NM
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I usually bill gynonc, not well woman, but I may be able to provide some advice.
1. Q0091 is specifically for the PAP collection, not for the pelvic/breast or a complete preventative exam. Medicare created the code, but a few private payors will also pay for it.
G0101 is for Medicare for a pelvic and breast exam. Why did Medicare deny this? Was it bundled with another service? Was it too soon?
2. S0612 I have never even heard of this code and needed to look it up. Ob/gyns performing a well-woman exam will typically provide and bill for a preventative exam 99384-99397. Again, what was the reason for the denial?

S0612 and Q0091 do not seem interchangeable. The codes describe different services.
If the patient comes in for birth control options and pap only. Do we still use a preventative E/M code 99384-99397?
 

csperoni

True Blue
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Selden
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99384-99397 should be used for comprehensive preventive evaluation and management services.
ie 99386: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
Your very, very, very brief description does not seem to indicate this is what was done, therefore that code would not be appropriate.
 
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