For our non-Medicare payers here in the Minneapolis area, G0101 and Q0091 are included in the preventive code. Medicare allows G0101 and Q0091 to be "carved out" and billed with the preventive visit.
99000 is a lab handling code and Q0091 is the pap hadling so are basically the same thing. Medicare doesn't cover 99000. They shouldn't be billed together. For non-Medicare patients you could bill 99000 but only if a venipuncture code isn't being billed also. Our payers here don't reimburse both when billed together.
If a patient comes in for just a pap/pelvic, then G0101 could be billed for the visit. Sometimes that happens when women have their physical but return on a later date for that portion.
You wouldn't need to bill with the 52 modifier because that is saying that is saying a lesser service was performed, not that you are reducing the charges. If you have a Medicare patient and carve out the G0101 and/or Q0091 and reduce the billed amount for the preventive med code, you would just bill the code as usual.
Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
AHIMA Approved ICD-10-CM/PCS Trainer
AAPC National ICD-10-CM Trainer