Results 1 to 3 of 3

Annual Exam for Medicare Patient's

  1. #1
    Default Annual Exam for Medicare Patient's
    Clearnace Sale
    Our providers are not only doing the pap/pelvic and breast exams. They are also taking vital signs, doing a ROS, PFSH, examining other body systems/areas, counseling, giving anticipatory guidance, etc. The Q0091 and G0101 codes do not capture the additional services the provider is providing. I believe we should be coding the 99391-99397 (preventative services) to the patient as a Medicare Carve out. Any insight?
    Christina Lee Wagner, CPC, CPC-H

  2. Default Medicare pxs
    If your docs are performing a comprehensive history and exam in addition to the breast and pelvic and the patient is not there to address complaints, I would say by all means, you should be billing a preventive visit. Keep in mind that Medicare will not pay for this visit and you would do best to inform the patients of this before they have their exam - even better to let them know at the time of sheduling. If your physicians are performing less than the comprehensive hx and exam but still more than just the pelvic and breast, you also have the option of billing an E/M code (99212-99214) with a preventive dx code. If the patients do not want to pay for the visit, work with your docs to establish a protocol so that these patients can be seen for just the breast and pelvic exam portion that Medicare will cover. Good luck!

  3. #3
    Default CMS carve out billing
    be sure to check out CMS's site relating to gynecologic screenings and their "carve out" billing policy
    example: charge for preventive visit for an established pt age 65 or older (99397) with collection of pap is $230
    Medicare's carve out rule requires you to "carve out" the cost of the breast/pelvic exam and the collection of pap. Say you come up with $50 for each G0101 and Q0091. This leaves $130 for 99397. Medicare will never cover this portion of the encounter. Most medicare suppliment policies will not cover it either as they only cover deductible and co-ins for allowed medicare services. Many patients are confused by this logic and informing them of their financial risk ahead of time is crucial.
    Also, for CMS compliance purposes, your ABN needs only to state that the collection of pap and the pelvic/breast exam are covered only q2yrs (if low risk) but does not need to include the 99387/97 as potentially being denied because these codes are NEVER payable under medicare rules. Though, as a courtesy and to avoid exhausting collections efforts on the back end, you should inform your patients up front of how much they will owe and why.

    Hope this helps

Similar Threads

  1. New patient for annual exam with sick visit
    Replies: 2
    Last Post: 01-27-2015, 10:52 AM
  2. Medicare Annual Exam
    By melheffley in forum OB/GYN
    Replies: 11
    Last Post: 06-18-2014, 12:26 PM
  3. Annual PE and new Medicare patient
    By asmrekar in forum Family Practice
    Replies: 3
    Last Post: 05-15-2013, 03:28 PM
  4. annual exam on medicare patient
    By mrolf in forum E/M
    Replies: 2
    Last Post: 04-19-2010, 07:33 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.