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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
    Default
    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

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

  3. #3
    Location
    Roanoke, Virginia
    Posts
    125
    Default
    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

    Marlena

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