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G0101 and Q0091

  1. Default Medicare GYN Exams
    Exam Training Packages
    As of Jan 1,2011 Medicare does cover Pap Smears every year.

  2. Smile Breast Exam
    Does anyone know what code to use if only breast exam is perform? and not the pelvic exam?

  3. Default
    So I have Medicare claims that are coming through with the pap code of 88164. I am working denial claims and everything that I have seen about Medicare and paps say nothing about code 88164. I am guessing that it is suppose to be a G-code but how do I know which G-code goes with the 88164. My list of Medicare codes for pap screening has 8 G-codes listed and 2 P-codes....any help from anyone would be greatly appreciated!

  4. Default Q0091 and G0101 for commercial payers
    I work for an Internist if we have a Patient who has BCBS of Mass . She comes in for an office visit billed 99213 and a pap . Can he bill both G0101 and Q0091? If not G0101 than what other code should he use? Thank you in advance!

  5. Default
    Quote Originally Posted by kemasters View Post
    If I bill Q0091 to an insurance that does not pay for that procedure seperately can I bill the patient? I am a salaried ObGyn office where the billing is done by the hospital. The coders insist on using Q0091 for all pap claims then billing the patient when the insurance doesn't pay--even Medicaid patients.
    You are going to bill the wrong patient and they are going to have your provider up the river. You cannot bill a patient for a service that their plan covers. Correct the coding first. And who bills Medicaid patients? It appears that someone has no clue of what they are doing if they are billing patients for covered services. The EOB will state clearly that patient is not responsible. I see an audit in your future.

  6. #16
    Default
    Quote Originally Posted by jouanlychen View Post
    does anyone know what code to use if only breast exam is perform? And not the pelvic exam?
    s0613
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  7. #17
    Default
    Quote Originally Posted by saoire View Post
    I work for an Internist if we have a Patient who has BCBS of Mass . She comes in for an office visit billed 99213 and a pap . Can he bill both G0101 and Q0091? If not G0101 than what other code should he use? Thank you in advance!
    First thing you want to do is check the carrier Medical Policy. Is your provider only submitting fir the specimen collection or is he/she doing he entire annual pap and pelvic exam?
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  8. #18
    Default Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection
    This came from a BC/BS policy...
    Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

    We would like to take this opportunity to remind providers that obtaining a Pap smear is integral to the office visit, including both preventive and routine office visits. Separate reimbursement is not allowed for HCPCS code Q0091.

    According to the American Congress of Obstetricians and Gynecologists, code Q0091 should not be reported to non-Medicare payers for Pap smear collection, as the collection of a Pap smear is included in the E&M or preventive service.

    The Q0091 code was developed by Medicare for the exclusive purpose of reporting services provided to Medicare patients. Providers should report this code to Medicare only for the collection of screening Pap smears for Medicare patients.

  9. #19
    Location
    San Antonio
    Posts
    33
    Default
    Quote Originally Posted by jouanlychen View Post
    Does anyone know what code to use if only breast exam is perform? and not the pelvic exam?
    I have this same question but it is a Medicare patient so an S code can't be used. I know I can bill the Q0091, but I don't believe I can code the G0101 because the pelivc exam wasn't done. Can I use modifier 52 for reduced service?
    Rey Gross, CPC, CMRS

  10. Default Gyn examination
    Hi, the way we bill gyn visit to medicare pt is using:
    Example:Preventive visit with screnning pelvic exam and pap smear ;

    99397(GY) with V72.31+ G0101(GA)or (GZ) with V72.31 or V15.89 +Q0091(GA)or (gz), and

    if pt has problem diag with bill it as :

    99213(25)+G0101(GA) with V76.2-V76.47-V76.49 or V15.89 + Q0091(GA)

    I HOPE IT HELP YOU

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