Wiki Billing Preventative & G0101 & Q0091 together

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az2tn@yahoo.com

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To all you GYN coders out there I have a question about the DX code you use when billing the preventative at the same time as cervical screening on a Medicare pt. So billing for example a 99397 and a G0101 & Q0091 at the same time. The preventative elements being other things examined except the GYN portion which is used to meet doc guidelines for G0101. Would you use V70.0 on 99397 instead of V72.31 and if not why? Any help would be greatly appreciated. Thanks! :)
 
No. You are supposed to carve out what you would get from G0101 and Q0091 from 99397. So if you get $20 for the G and Q code each then you would "carve out" $40 from what you would get paid for the 99397 (which isn't covered by Medicare so you would deduct that from what the patient would owe).

I do believe that's how it works..... I havent been on the Billing side for awhile and am having to re-learn all the Medicare/Medicaid mumbo jumbo :p

You would still use V72.31
 
There are differing opinions about using 99397 along with G0101 and Q0091. I have seen patients billed after the adjustment is made and they are angry because they thought the visit would be covered. They don't understand. Also, you shouldn't use V70.0 for Gyn.
 
Still confused about this. And having other issues with OB as well. What confuses me about this is the preventative portion where the lungs,heart,extremities etc is seperated from the GYN portion so why wouldn't you use V70.0? Also have been noticing several of our OB clinics billing pts who have AARP Medicare and Humana Gold Plus with just the preventative and they are paying. I know traditional Medicare does not cover these so was surprised to see this. So do we bill the G0101 and the Q0091 with that as well to Medicare replacement plans that cover preventative or would this be included? Any insight is greatly appreciated. Thanks!:)
 
Medicare preventative

I bill V72.31. I explain to the patient the Medicare rules and have them sign the ABN. I
actually have the 99397 on the ABN as a courtesy explaining that this is not a covered service and carve out the pap prep and breast/pelvic exam.This way they are not surprised when they get their statements. ACOG has some really helpful information on this also.
 
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