Wiki Well Women CPT codes

[oskolkoff]

We have new staff. It has lead to new questions on cpt codes for Well women visits and Comprehensive Preventive medicine. What are the correct cpt codes to use for:

1. Well Woman visit, only Breast exam and PAP for woman not enrolled with Medicare
2. Well Woman with PAP and Annual PE for woman not enrolled with Medicare
3. Well Woman visit, only Breast exam and PAP for woman enrolled with Medicare
4. Well Woman visit with PAP and Annual for woman enrolled with Medicare.

Our clinic is having questions when to use G0101 and Q0091. Do the comprehensive preventative medicine codes 993xx include these services in non-medicare pt? Should G0101 and Q0091 be used for a Well woman visit that only covers a gyn & breast exam with PAP for Medicare pt and non medicare pt? Does comprehensive preventative medicine codes 993xx cover a Well woman visit that only covers a gyn & breast exam with a PAP?

Any help would be great.
Thanks, Jennifer

 

[bonzaibex]

Yes, the G0101 & Q0091 codes are included in the 993xx codes. The G0101 & Q0091 codes are used to "carve out" those pieces/services that Medicare will pay for from the rest of the 993xx bill that Medicare will not allow. You bill all 3 codes to Medicare. Medicare will deny the 993xx code as an non-benefit and put it to pt resp. Medicare will allow the G & Q codes (providing medical necessity is met & frequency is not exceeded). The amount that Medicare allows on the G & Q codes must be subtracted (or "carved out") from the 993xx amount before you bill the patient.

For example, let's say the normal fee for a 99396 is $250.00, and Medicare allows a total of $75 on the G0101 AND the Q0091 codes. You may bill the patient for $175.00 on the 99396.

Most commercial carriers will allow the 993xx code, and the G0101/Q0091 services are included in the 993xx service. You don't have to carve out those pieces, so you don't bill them to the insurance.

As far as coding for your 1-4 scenarios, you have to review the documentation against the CPT guidelines to determine whether the 993xx code is appropriate or not. If the note does not reflect the "evaulation & management of an individual, including an age and gender appropriate history, examination, counseling..." etc, then you should code only the G0101/Q0091 services as done along with the appropriate dx code (V76.x leaps to mind). If the patient's particular insurance carrier won't accept the G & Q codes, you can always use a 9920x or 9921x code instead.