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Who's using these codes S0610,S0612,S0613 & why?

  1. #1
    Default Who's using these codes S0610,S0612,S0613 & why?
    Medical Coding Books
    I'm very familar with CPT codes 99381-99397, which apply to well visits and physicals and well womens.

    But I've come across thes codes.

    S0610-Annual gynecological exam-new pt.

    S0612-Annual gynecological exam-est. pt.

    S0613- Annual gynecological exam, clinical breast exam without pelvic exam.


    Which these are Temporay national HCPCS codes.

    My question is why in the world were these issued out, and does anyone apply them to there daily practice. If so are you getting reimbursed.

    Looking for ways to increase revenue in my practice.

    Respectfully

    Daniel
    CPC

  2. #2
    Location
    Charleston, South Carolina
    Posts
    641
    Cool S codes
    If you look in the guidelines in the S codes in the HCPCS book, you will see that they are for BCBS. They are used to meet needs in the private sector.

    Hope that helps.

    Machelle

  3. #3
    Default
    I agree with everthing you wrote, but I still don't see why and the benefit to using these S codes. Every time I've coded a well women to BSBC, I've used the Preventive CPT codes. 99385-99387-99395-99397. And have seen no problem in getting these paid.

    So why in the world were these created.

    Still curious.

    Respectfully

    daniel cpc

  4. #4
    Default S0610, S0612, S0613
    I do believe these codes are for tracking purposes (billiable only to BCBS) and also to distinguish that the patient was in specifically for a gynecological exam vs a comprehensive preventive medicine examination.

    Pualiilii, CPC

  5. #5
    Default S0610, S0612, S0613
    If you are in PA, BCNEPA/FPH is also using these codes with V72.31. Why? They are specifically for the Routine GYN exam. They are paying comparable to what the preventive med codes pay. It is specific to the Routine Gyn Exam which includes the Pap, Pelvic, and Clinical Breast Exams. S0613 does not include the Breast Exam. With quality reviews and all, I would imagine they are attempting to track who is getting their GYN exams.

  6. #6
    Default
    i know someone that used them......they pay less than the preventative codes by BC/BS

  7. #7
    Default
    Hello!
    You know about the G0101, right? And the Q0091?
    Leona Kiamahoe CPC, CPC-H, CPC-P

  8. Talking
    Quote Originally Posted by Pualiilii View Post
    I do believe these codes are for tracking purposes (billiable only to BCBS) and also to distinguish that the patient was in specifically for a gynecological exam vs a comprehensive preventive medicine examination.

    Pualiilii, CPC
    In the state of Ohio, these codes are used for Medicaid patients with a modifier FP for family planning. Mediciad will pay for these codes whenever a patient comes in for any related family planning office visit.

  9. #9
    Default
    when billing BCBS is it better to use the prev med e&m code with a S-code for a gyno or use a prev med code & a v-code? I need to make sure I differentiate that the exam I am going to bill for is a gyno becuz later I need to bill for a complete physical

  10. #10
    Default
    I use them for the payors that allow them. Why? Because sometimes the patient will come in for a comprehensive PE by their male doctor and 3 months later, come back to see the NP for just her GYN exam & Pap.

    Here's the guidelines I use (I'm in MA) (sorry about the formatting, didn't copy well here):

    Coding & Billing for Medicare GYN Exams

    • Use HCPCS codes G0101 (screening pelvic & breast exam) AND Q0091 (obtain cervical or vaginal smear) with one of the diagnosis codes below:
    • If patient is HIGH-RISK, use diagnosis code V15.89
    • If patient is LOW-RISK, use diagnosis code V72.31

    PART TWO โ€“ All other payors
    Use V72.31 as the diagnosis. See payor-specific guidelines below for procedure coding requirements.

    AETNA
    • S0610 for NEW patients
    • S0612 for ESTABLISHED patients
    • If complete PE is also done (V70.0), bill only the age-appropriate preventive exam


    BCBS โ€“ EXCEPT FOR BLUE CARE 65 AKA MEDICARE ADVANTAGE HMO
    • S0610 for NEW patients
    • S0612 for ESTABLISHED patients
    • Exception โ€“ NPs can NOT bill these codes if they are billing direct (under their own names, doc not in office). If supervising doc not in office and NP billing direct, then use the G and Q codes instead.

    *** IF COMPLETE PE (V70.0) ALSO DONE, BILL THE AGE-APPROPRIATE LINKED TO V70.0 AND THE G0101 LINKED TO DX v72.31 *** instead of the S-code. (The S codes bundle into any other E&M done on the same day.) This applies also if a separate problem is addressed โ€“ If a problem visit also done (e.g. 99213), bill that with -25 modifier linked to problem dx and then the G0101 linked to V72.31


    BLUE CARE 65 / MEDICARE ADVANTAGE HMO
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill the age appropriate exam linked to V70.0 plus the G0101 and Q0091 linked to V72.31 (Q code may deny as bundled)


    BMC HealthNet
    • Use age-appropriate preventive exam (e.g. 99395)


    Cigna
    • S0610 for NEW patients
    • S0612 for ESTABLISHED patients
    • If complete PE is also done (V70.0), bill only the age-appropriate preventive exam


    Connecticare
    • Use age-appropriate preventive exam (e.g. 99395)



    Consolidated
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill the age appropriate exam linked to V70.0 plus the G0101 and Q0091 linked to V72.31 (Q code may deny as bundled)


    Coventry
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill the age appropriate exam linked to V70.0 plus the G0101 and Q0091 linked to V72.31 (Q code may deny as bundled)


    Fallon
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill the age appropriate exam linked to V70.0 plus the G0101 and Q0091 linked to V72.31
    • If a PROBLEM visit 99214, 99215, 99203, 99204, or 99205 is also indicated, bill ONLY the problem visit.
    • If a Problem visit 99212, 99213, 99201, or 99202 is also indicated, bill only the G and Q codes.


    GIC/UNICARE
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill only the age appropriate exam (the G & Codes bundle).
    • They will pay for a separate problem visit w/ mod -25


    Great West
    • S0610 for NEW patients
    • S0612 for ESTABLISHED patients

    *** IF COMPLETE PE (V70.0) ALSO DONE, BILL THE AGE-APPROPRIATE LINKED TO V70.0 AND THE G0101 LINKED TO DX v72.31 *** instead of the S-code. (The S codes bundle into any other E&M done on the same day.) This applies also if a separate problem is addressed โ€“ If a problem visit also done (e.g. 99213), bill that with -25 modifier linked to problem dx and then the G0101 linked to V72.31


    Harvard Pilgrim
    • G0101 and Q0091
    • If regular complete PE (V70.0) also indicated, bill the age appropriate exam ONLY (G & Q bundle w/ any other E&M service)
    • If problem visit also indicated, bill ONLY The G & Q codes.


    Health New England
    • Use age-appropriate preventive exam (e.g. 99395)


    MassHealth
    • Use age-appropriate preventive exam (e.g. 99395)


    Network Health
    • G0101 only (Q0091 bundles)
    • If complete PE is also done (V70.0), bill only the age-appropriate preventive exam


    Tricare
    • G0101 only (Q0091 denies as bundled)
    • If complete PE or problem visit also indicated, bill only E&M as Tricare bundles the G and Q codes into any other E&M on same day


    Tufts (NON_MEDICARE TUFTS ONLY)
    • S0610 for NEW patients
    • S0612 for ESTABLISHED patients

    *** IF COMPLETE PE (V70.0) ALSO DONE, BILL THE AGE-APPROPRIATE LINKED TO V70.0 AND THE Q0091 plus G0101-59 LINKED TO DX v72.31 *** instead of the S-code. (The S codes bundle into any other E&M done on the same day.) This applies also if a separate problem is addressed โ€“ If a problem visit also done (e.g. 99213), bill that with -25 modifier linked to problem dx and then the G0101 linked to V72.31


    Tufts Medicare Preferred:

    • G0101 ONLY (Q0091 is bundled per their policy)

    *** IF COMPLETE PE (V70.0) ALSO DONE, BILL THE AGE-APPROPRIATE LINKED TO V70.0 AND THE Q0091 plus G0101-59 LINKED TO DX v72.31 This applies also if a separate problem is addressed โ€“ If a problem visit also done (e.g. 99213), bill that with -25 modifier linked to problem dx and then the G0101 linked to V72.31


    United Healthcare
    • G0101 and Q0091
    • If complete PE (v70.0) also done, bill only the age-appropriate code; UHC bundles the G&Q codes in to the 993xx codes.

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