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Billing for Gyn Exams when Medicare is secondary

  1. #1
    Location
    Harrisburg, PA
    Posts
    38
    Red face Billing for Gyn Exams when Medicare is secondary
    Medical Coding Books
    I am having a problem when patient has Pennsylvania Blue Shield or Blue Cross as primary and Medicare as secondary, when billing a routine Gyn Exam using S0612 for an established patient. Medicare does not accept the local code of S0612. Is there some other way I should be billing this so Medicare will pay as secondary since they do not accept S0612.

  2. #2
    Location
    Kansas City, MO
    Posts
    751
    Default
    The only codes that Medicare recognizes are the G0101 (Pelvic/Breast exam) and Q0091 (Obtaining Pap Smear) every 24 months for low risk and every 12 months if high risk.

    http://www.cms.hhs.gov/MLNProducts/d...nceChart_1.pdf
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  3. #3
    Location
    Harrisburg, PA
    Posts
    38
    Default
    We do use the G0101 and Q0091 when patient has Medicare as their primary insurance. But in this case Medicare is secondary and the primary insurance does not recognize the G0101 and Q009.

  4. Default
    I don't think it is too much of an issue because Medicare allowable will be less than the primary so they would not pay additional anyway, correct?

  5. #5
    Location
    Harrisburg, PA
    Posts
    38
    Default
    You are probably right on that. We are just trying to get Medicare to pay the patient's copay.

  6. Default
    THis is a little off the subject but I was under impression that G0101 includes Q0091 (even though Medicare pays for both codes). Does anyone know if its ok to bill medicare for BOTH codes on same DOS???

  7. #7
    Default off subject
    Quote Originally Posted by dan528i View Post
    THis is a little off the subject but I was under impression that G0101 includes Q0091 (even though Medicare pays for both codes). Does anyone know if its ok to bill medicare for BOTH codes on same DOS???
    Yes you can bill both on the same DOS. We do anyway, the G0101 is for the breast/pelvic exam and the Q0091 is for the pap smear collection. We use the V72.31 with the G0101 and the V76.2 with the Q0091. This is one of those that everyone will have an opinion on and will do differently so there may be several different ways that this is billed. Our facility does it this way.
    Good luck!

  8. Default
    ok thanks. I read somewhere that G0101 INCLUDES ALL SMEARS. thats why we stoped billing both on same DOS.

  9. Default
    Quote Originally Posted by cbooker View Post
    We do use the G0101 and Q0091 when patient has Medicare as their primary insurance. But in this case Medicare is secondary and the primary insurance does not recognize the G0101 and Q009.
    Hi cbooker,

    Did you ever find a solution to this? The primary in my case applied it all to the patient's deductible, so there is a large balance, but Medicare does not recognize the CPT code used for the primary insurance (99396).

    Thanks

    Lisa

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