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Annual Gyno Exam Coding

  1. #1
    Default Annual Gyno Exam Coding
    Medical Coding Books
    I do the billing for a family practice group and they are requesting we bill each insurance differently for the annual gyno exams.
    They're requesting we bill:
    Medicare Patients as G0101 & Q0091
    Blue Cross Patients as S0612 & Q0091
    All other Insurances as the 99 preventitive code and the Q0091.

    Is it acceptable to bill 3 different ways for the exact same procedure?

    At times the commercial payers are denying the Q0091, can the patients be billed for the pap collection?

    Thanks in advance for any advice

  2. Smile
    Here is the correct way to bill Medicare: 993xx-GY, G0101-GA, Q0091-GA
    Modifier GY indicates, that this is a non-covered Medicare Service submitted for secondary consideration. Modifier GA indicates that a Medicare ABN has been obtained (provided that all criteria has been met at tos).

    Regarding commercials, submit the services according to their guidelines. Blue Shield has always been a class on its own regarding coding. Many comercials consider that the Q0091 is bundled within the 993xx and according to many insurance contracts, inappropriate to bill the patient. It's always recommended to know coding/billing requirements for all carriers.

  3. #3
    Default Thank you!
    Thank you for your response!

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