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Billing Preventive Visit

  1. #1
    Default Billing Preventive Visit
    Medical Coding Books
    When Medicare denies G0101, Q0091 for max coverage met, can we bill secondary 99381-99397 as appropriate.

    And when Medicare pays G0101, Q0091 can we carve out and bill balance to secondary or the patient.

    Seems tricky...


  2. #2
    When a Medicare patient comes in for a preventive visit and a pap and pelvic is done, do you bill the CPT for the preventive visit at all? If that is what they are doing, you should bill those codes, and the G0101 and Q0091 as appropriate in addition to those codes and then carve out or subtract the billed amount of G0101 and/or Q0091 from the preventive CPT billed charge. That lessens the amount the patient is responsible for but charges them appropriately for the services performed.
    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

  3. #3
    Greeley, Colorado
    Pam is correct. You should code 99397/G0101/Q0091 as appropriate. The carve out scenario would add up to your actual fee for 99397 and no higher.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Thank you guys!

  5. Default
    What I can tell you is that usually if Medicare doesn't allow, neither does the secondary. E&B from that insurance company will usually quote that w/ benefits.

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