You DO carve out the G0101 & Q0091--they are part of the preventive exam and you are "carving out" the portion of the exam that Medicare will cover. You do NOT carve out the problem E&M code. The documentation must support a significant & separate visit relating to said problem over and above the preventive documentation. In other words, you can't use the bullet points from the preventive examination to meet components of the problem exam. But the problem exam is over and above, and therefore isn't carved out from the preventive exam.
Hope that made sense....
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