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G0101 and Q0091 payable on same DOS

  1. Default G0101 and Q0091 payable on same DOS
    Medical Coding Books
    Can anyone please help me with this:

    Eventhough G0101 and Q0091 are Medicare codes, Health Plus in NY recognizes and pays for both codes on same DOS. Now I've recently learned (thanks to certain members on this cite-Thanks again for that), that G0101 when billed INCLUDES PAP Smear. Also, Health Plus does not pay for annual c/u and well visits. Now here is the question: If Q0091 is included in G0101 by CMS guidlines WHY Would the ins. comp. pay for both codes 100% of the time.

    !!!! Thanks in advance for all opinions !!!!!

    P.S. Health Plus is by far not the only company that does this.

  2. #2
    Kansas City, MO
    Here is the difference:

    G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination (This is the actual physical exam)

    Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory (This is the actual collection of the pap smear specimen)

    The G0101 exam can be billed if the pap is or is not performed. The Q0091 is for the physicians work of actually collecting the pap smear. Is Health Plus a Medicaid program? As for the question why, some companies that don't pay for "routine physicals" may have opted to follow Medicare type rules to pay for this very important exam and test. There are some BCBS plans that don't cover routine physicals, but they instead use a group of S codes to report the same elements of a pap and pelvic.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

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