Wiki Annual Physical for Medicare Patients

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Mali0114

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In our OB/GYN practice we often times have Medicare aged women come to our Dr's for their pap and exam. What is the best way to bill this? Our Physicians usually mark the 99397 on their superbill. Often times the visit entails more than just the pap and woman exam itself,(just as the 99397 does) and it goes beyond the G0101, so just G0101 doesn't seem sufficient.
 
Mali0114 said:
In our OB/GYN practice we often times have Medicare aged women come to our Dr's for their pap and exam. What is the best way to bill this? Our Physicians usually mark the 99397 on their superbill. Often times the visit entails more than just the pap and woman exam itself,(just as the 99397 does) and it goes beyond the G0101, so just G0101 doesn't seem sufficient.
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Are you also utelizing the Q0091 to capture the pap? If there are problems he is addressing that go beyond the scope of a well woman an office level could be charged with a -25 modifier on the level.

G0101 = pelvic and breast
Q0091 = pap

These are Medicare only codes specifically to address the PPB

I hope this helps :)
 
Thank you. I was sure that I read somewhere that Medicare no longer allowed the Q0091. Today I found documentation showing that it is still allowed. I doesn't appear that the pap has to be collected in order to bill G0101. That is like you say, what Q0091 is for. Do you understand it the same way?
 
The way our practice bills for medicare is:

G0101 & Q0091 with an icd9 dx of V15.89

We always get paid for both of these codes.

I hope this helps :)
 
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