# Medicare Billing for a Well Woman Visit



## kenkie79 (Nov 5, 2014)

How in the world do you bill them?  I had always been billing them with an E/M code and the G0101 and Q0091 (IFF they got a pap smear).  I would use a diagnosis code that described their problems (usually 616.10, 788.31, 627.3) and then the V15.89 and V76.2 respectively of the G0101 and Q0091 code.  No problems.  

Now I'm looking on Novitas site and thinking why not bill it with the G0439 (subsequent well visit) and the G0101 and Q0091 codes.  How do you guys bill for well woman routine visits for the Medicare patients?


----------



## Pam Brooks (Nov 5, 2014)

Q0091 and G0101 report only the pap, breast and pelvic exam (there are specific exam criteria) but it doesn't include an exam of any other body areas.  Medicare does cover this under certain circumstances.

G0439 is an Annual Wellness Visit, but note that this is not a regular preventive exam.  It's more of a risk assessment.  There are certain documentation and review criteria that must be met before you bill these, although you can bill them with the Q0091 and G0101.  . 

The 9939x is truly the code to use for a well woman exam.   You can bill this with the Q0091 and G0101, but here's the thing...CMS does not reimburse those preventive medicine codes.  They do pay the pap/breast/pelvic, but the rest of the visit will be patient responsiblity.  

Using an E&M code as a well woman visit isn't an appropriate use of the codes in the 99201-99215 range.  Those are specifically used to report problem-oriented visits (i.e. sick visits).  

There's no great answer.  If a Medicare recipient insists on a preventive exam outside the Q0091 and G0101, we of course provide one by billing 9939x along with a notification of non-coverage so that they are aware of the cost.


----------



## kenkie79 (Nov 19, 2014)

Thank you so much for that.  And this is likely why people don't take Medicare patients.  We get very little just for the G0101 and Q0091 codes.  When the patient's come here, we usually are dealing with their atrophic vaginosis, osteoporosis, etc issues.  So we are prescribing them things for it.  We also follow up on cystoceles and things like that from the last time they came (monitoring their pessary) so it's usually good.  But sometimes I feel a bit uncomfortable when they put Hypertension as their reason for coming.  We're a GYN practice, we don't really have much to do with that portion of the care.


----------



## PrasannaL (Mar 13, 2015)

*Medicare Routine Gynecology visit cum Annual visit*

Hi all,

I'm working with OBGyn Practice coding and got confusion in coding routine gynec visit and Annual visit for Medicare. I wants to know what makes the difference in billing these visits. As of now i'm assigning cpt G0101 and Q0091 for routine gynec visit but the providers stating it's having low fee value compared to commercial and medicare covers only once for 2 years but how to bill actually for annual and routine gynec visits. can i assign G0439? but it wont covers cervical cancer screening and pap smear. Please help me getting conslusion in billing such scenario.

Thanks and regards
Prasanna.


----------

