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G0101 and Q0091

  1. #1
    Default G0101 and Q0091
    Medical Coding Books
    I have a doctor who wants to know if G0101 can be billed with Q0091?
    He wants to bill a visit code of 99385 also? Isn't Q0091 part of G0101?

  2. Default Jeanie Roberts CPC
    I do Ob/gyn coding and from my notes it says Q0091 is billed for doing the screening pap smear and G0101 is billed for the pelvic exam and breast check. So if both were done, you use both Q0091 and G0101 for medicare patients and you need to use diagnosis V76.2. Medicare will pay for this every two years and if the patient meets Medicare's criteria for high-risk, the exam is reimbursed every year.
    Medicare preventive coverage includes a pelvic examination & breast check (G0101) and collection of Pap smear speciment (Q0091). It does not include other services normally included in a preventive exam, such as taking vital signs, examining skin, heart, lungs, and reviewing systems, past family and social history.
    If more than one preventive service is provided during the same encounter, a physician should submit the screening codes to Medicare for payment (G0101/Q0091) and the preventive code 99285 etc to the patient for payment. The amount reimbursed by Medicare for the covered screening services is deducted from the amount billed to the patient for the other preventive services.
    Example: annual gyn exam. Medicare covered the pap smear, pelvic exam & breast check. Doctor charges $120 for an annual exam. Dr. bills Medicare $33.68 Pelvic & breast exam and $50.58 collection of pap smear, and bills cpt 99385-52 (Preventive Med new pt) $35.74 to the patient and the Total is $120.00.

  3. #3
    Seacoast- Dover New Hampshire
    That is an excellent description of a carve out that I have seen. To take that one step further, we get paid for Q0091 from other insurances as long as that is the only thing done on that day. I do not believe that you can use this with the E&M or Routine PE and get paid for it. We are a CAH and our providers get RVU's for this code.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. Default
    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.

  5. #5
    Seacoast- Dover New Hampshire
    What does the eob state? We do not bill medicaid pt for anything. They are written off. I do believe that this is one of the "Provider Liable" clauses.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    I need a little clarification for coding Medicare patients and non Medicare patients for their annual exam/pap.

    Medicare pt example : 99396, G0101, Q0091

    Non Medicare Patient example : 99396, 99000, Q0091.

    Isn't it correct that the 99000 and Q0091 are both the handling fee?
    If so, is there a different code for the G0101 for non Medicare patien't or do you bill the G0101 to the commercial insurances as you do for Medicare?

  7. #7
    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, 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

  8. Question Billing for Medicare Annual Exam
    I have a Medicare patient who had an annual exam on 10/6/09 and returned 11/12/10 for another annual exam. The physician also billed an e/m 99213 on the same day. She has a hx of br ca, would this be considered HR and billable to Medicare? What HR dx code can be used to indicate to Medicare this is a High Risk patient?

  9. #9
    I did the webinar with AAPC for OB/GYN updates for 2011 and according to medicare these are some of the reasons specified for high risk and the ICD-9 to use:

    -child bearing age:
    -cervical or vaginal CA is present
    -abnormal findings in the last 3 years
    -considered high-risk for developing cervical or vaginal CA
    -non child bearing age:
    -onset sexual activity under 16 years of age
    -5 or more sexual partners
    -fewer than 3 pap smears in the last 7 years
    -no pap smears in 7 years
    -exposed to DES in utero

    Hope this helps,
    Ivonne, CPMA

  10. Default
    I work in a OBGYN office as well. For well woman exam we bill:
    G0101-GA and V76.2 code.
    Q0091-GA for specimen /pap

    On occcasion if the patient has a problem in same visit, the doctor will bill 99213-25.

    Medicare only pays every 2 years and the patients are required to sign a waiver

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