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medicare and carve outs

  1. #1
    Grants Pass
    Default medicare and carve outs
    Medical Coding Books
    For medicare carve out on a preventive exam, which is 99384 thru 99397-wondering if we can subtract G0101, Q0091 and a 99201 thru 99215? Can we do all three, I've seen examples of either carve out for breast and pelvic (G0101 and Q0091) or problem visit but not both.
    thanks for any advice

  2. #2
    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....

    Becky, CPC

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