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Well Woman Coding w/ Family Practice---HELP!!!!

  1. #1
    Question Well Woman Coding w/ Family Practice---HELP!!!!
    Medical Coding Books
    I am really needing help coding well woman exams under family practice. I am confused. When a patient comes in for a pap smear with commerical insurance..I would normally code it this way:
    9939X-V721.31

    If a Medicare patient comes in, I would code it....

    99397-V72.31
    G0101-V72.31

    I am not sure this is right. Do you charge a 99397 or 9921X on a Mcare patient along with the G, or do you just code the G0101? OOOOOOHHHHH, I really need a seminar on this topic. Please help anyone! Thanks!

  2. #2
    Default
    We code the preventive E/M with V70.0. CMS has certain criteria for billing HCPCS G0101, if you're going to pull that out. Here are some resources:
    http://www.cms.hhs.gov/MLNProducts/d...nceChart_1.pdf
    http://www.cms.hhs.gov/transmittals/...ds/R1694B3.pdf
    http://www.wpsmedicare.com/part_b/bu...services.shtml

    I hope that helps.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. Smile
    YOU DO NOT USE PREVENATIVE CARE FOR MEDICARE PT, WE ONLY USE 9921X WITH V72.31 OR V70.0. WE USE IT IN OUR FAMILY PRACTICE ALL THE TIME. TRY IT. HOPE THIS HELPED.

    MsMaddy

  4. #4
    Default
    Medicare doesn't cover a preventive visit but if a preventive visit was done, then a preventive code is billed. A "problem E/M" 99201-99215 is not billed with V70.0. I would be surprised if those are getting paid. Medicare does cover G0101 and Q0091 so I would look into those and then, if they are performed and billed, then the billed charge of those are subtracted or "carved out" of the cost of the preventive visit, reducing the Medicare members responsible amount.

    The "Welcome to Medicare" physical is also covered so it's important to know if the patient has that benefit too.
    http://www.cms.hhs.gov/MLNProducts/d...I_IPPE001a.pdf
    http://www.cms.hhs.gov/ContractorLea...ads/JA6223.pdf
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  5. Default
    For a commercial patient you can bill the preventive exam with the V72.31 for a well woman and bill her pap. For Medicare you bill the G0101 for the pelvic and breast exam and the Q0091 for the collection of the pap. Make sure the physician documents in the patient's record that a "pap was obtained". I know it seem redundant but to bill the Q code you need to have that documentation in the chart.

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