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Medicare Preventative exam

  1. #1
    Default Medicare Preventative exam
    Medical Coding Books
    Can someone please help me to better understand billing medicare for well women GYN exams. In our office we bill 99397 with G0101 and Q0091 and carve out the 2, However I have a physician who is now adding S0612 to the mix. I feel this is incorrect coding and is only used for primary care physicians not OB/GYN.

  2. #2
    Columbia, MO
    Why are you using the 99397 if this is a Medicare Pt? and the S codes are non medicare. If this is an annual plus well woman the you use the G0438/G0438 plus the G and the Q codes.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    We bill the 99397 for the preventative exam and the G and Q code for the pap, pelvic and breast exam.

  4. #4
    I would be carefull about billing the Wellness Visit if the patient is coming in for PAP. The G0438 must have the following documented:

    What is included in an Initial AWV with PPPS?
    - Medical and family history
    – List of current medical providers
    – Height, weight, BMI, BP and other appropriate routine measurements
    – Detection of cognitive impairment
    – Review risk factors
    – Review of functional ability
    – Establish a written screening schedule for next 5-10 years
    – Establish list of risk factors
    – Provide advice and referrals to health education and preventative counseling services
    – Other elements as determined by the Secretary of Health and Human Services

    Is your provider documenting and doing all of this at the same time they are doing the PAP? We only bill G0101 & Q0091 as appropriate and per documentation. If you charge the 99397 and carve out the price for the G & Q code, the final price of 99397 should be a write off because it is not covered by Medicare.

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