Results 1 to 3 of 3

Preventive, Breast Pelvic, and Pap for Medicare Patient

  1. Default Preventive, Breast Pelvic, and Pap for Medicare Patient
    Medical Coding Books
    One of our coders made the point that our providers' document a preventive service plus a breast/pelvic exam (G0101) and a pap (Q0091) for Medicare patients. Her experience is that the preventive can still be billed although not payable by Medicare. If the patient has a secondary such as a Medicare Advantage Plan, they often pick up the preventive. Just wondering if others have similar experience/knowledge? From a documentation perspective, I would agree this is correct coding.

    Thank you

  2. #2
    At the clinic i work at, it's our policy to bill the preventive px with a GY mod and then reduce the price of it by subtracting the cost of the G0101 (if at least seven components were met...) and Q0091

    99397-Gy $246.58
    G0101 -78.95
    Q0091 -75.71
    TOTAL $91.92 for px

  3. #3
    Roanoke, Virginia
    Can't say I've seen a secondary insurance pay when a charge has been disallowed by Medicare. Generally, Medicare has to allow the charge first. That said, I've seen the annual Medicare physical (G043_), pelvic exam (G0101), and Q0091 paid together.

    Good luck


Similar Threads

  1. Pap and Pelvic exama
    By tracyll in forum Family Practice
    Replies: 7
    Last Post: 08-13-2015, 10:24 AM
  2. Pap/ pelvic only?
    By cglasg2151 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-30-2012, 12:43 PM
  3. Replies: 8
    Last Post: 12-09-2011, 02:30 PM
  4. Pap smear for a Medicare patient who had a hysterectomy for uterine cancer
    By debdunning in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 10-22-2010, 02:27 PM
  5. Medicare Pap and Pelvic Exam
    By andi in forum Family Practice
    Replies: 4
    Last Post: 09-17-2009, 06:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.