# G0101 and Commercial Insurance



## Saedron (Apr 18, 2015)

I am having a bit of a battle and need some support!

First, some background: These are non-medicare patients in a primary care practice that are returning for a preventive pap/pelvic exam that was not conducted during a routine physical visit.

I have recently had my primary care providers send me problem focused visit codes (99201-99215) with a preventive diagnosis V72.31, V76.2. I have sent these back for clarification because I receive denials on these all the time from my commercial carriers, and for good reason. My providers are anxious because they are not getting paid in this manner of claim submission and I had to find a way. 

I have picked up the phone and called my major carriers (BCBSNC, UHC, Cigna, Aetna, and Human) and they have all assured me that they will pay on the G0101 as a stand alone preventive code. I also have printouts of the carriers that publish policies on this code as a backup.

(I do not want to go into the Q0091, so please, leave that one alone for now.)

Based on the conversations I've had with these carriers, I've sent out claims and the claims have been paid. I am getting a very favorable response in billing the G0101 to commercial carriers. 

Now, I am getting heat from some coders that billing this code is wrong. They claim that I am getting paid now, but that commercial will recoup the money after a time. While they can show me no proof that this will happen, they are adamant commercial payment will not stick. 

So, if you are still with me, what is your experience in family practice billing a G0101 to commercial insurance and having the reimbursement stick. 

Thank you!


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## cocstudent1 (Apr 18, 2015)

*G0101*

Hello I am concerned that you mentioned that you were having trouble with the V72.31 and V76.2.  I have not experienced any problems with these diagnosis and take back.  Are you billing for any other procedures?  I have experienced denials from this.  I will keep checking to see what happens with these orders. Thank you for the update. Karen Fan CPC coc.


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## mitchellde (Apr 19, 2015)

Saedron said:


> I am having a bit of a battle and need some support!
> 
> First, some background: These are non-medicare patients in a primary care practice that are returning for a preventive pap/pelvic exam that was not conducted during a routine physical visit.
> 
> ...



Many commercial carriers use the G0101 and the Q0091 for the well woman, there is no problem with this. Just check with the payers fee schedule first. 
One other thing thought you do not code the V76.2 with the V72.31 check your code book.  It is considered inclusive.


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## Saedron (Apr 19, 2015)

Thanks for the responses!

I know those diagnosis codes don't go together, perse. I simply meant that my providers will send me a 99212, V76.2 OR a 99213, V72.31. Stuff like that. 

I'll keep on sending them out!


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