Wiki G0101 denied

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jordway

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We are getting denied by Medicare for coding G0101 for our patients. They are being seen for their annual exam and it has been two years since the last exam. The denial states patient ineligible for this service??? Has anyone else run into this problem?? It also states it is non covered visit??
 
I always double check part B coverage was in effect at the time of service...

We use V76 series codes since G0101 is a screening code. Perhaps V72.31 is causing the problem as Medicare doesn't cover annual "physicals" but they cover screenings. This may be more likely if this is denial occurs w/ all your Medicare clients and you are billing them all with G0101/V72.31
 
G0101

I have a question about this as well.... Is this code only for Traditiional Medicare patients or does this code also apply for Medicare HMO's? Would appreciate an answer. Thank you!
 
annamarie1968 said:
I have a question about this as well.... Is this code only for Traditiional Medicare patients or does this code also apply for Medicare HMO's? Would appreciate an answer. Thank you!
Click to expand...

It really depends on the health plan. More and more of them (Blue Cross, for example) are requiring the G code, instead of the 993- series effective 2014.
 
G0101

We too are getting denials stating non covered visits. We have been using the G0101 linking with V72.31 and in the past have had no problems getting this paid. Since 01/2014 we have been getting denials on our Medicare patients for these codes. Help?
 
I use G0101 with V72.31 and get paid. V15.89 as secondary if the patient is high risk and G0101, GA if they signed an ABN. I would bet anything the patient's PCP is billing G0101 as well and that's the reason for the denial. Call the Medicare provider line and go from there. Good luck!
 
This information was shared within my organization:

Re: Medicare coverage of preventive services provided in the RHC setting.

Effective January 1, 2014, CMS is no longer considering G0101 or Q0091 as medically necessary face to face visits in RHC setting.

In order to be reimbursed RHC rate for performing these preventive services, the provider must also provide a face to face E/M service.
 
We had that same problem of denials with procedure code above so we started using v72.31 & G0439 & no more denials & Medicare is paying.
 
I would reference NCD 210.2 at this link
http://www.cms.gov/medicare-coverag...ails.aspx?NCDId=185&ncdver=3&bc=AgAAgAAAAAAA&

Your dx does show to be a covered dx per this ncd.


This is at the bottom of the link page and you can click to see covered dx. I have several issues open with Medicare currently in regards to denials based on recent NCD change noted below. This may be related to this change and denials may be inappropriate?

05/2014 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/06/2014 Effective date: 10/1/2015. (TN 1388 ) (TN 1388 ) (CR 8691)
 
I've been billing for an ob/gyn for years and I (knock on wood) have had no problems billing the G0101 with the V72.31. I would call your carrier. Is it ALL your mcare patients?
 
bdgonzwil said:
We had that same problem of denials with procedure code above so we started using v72.31 & G0439 & no more denials & Medicare is paying.
Click to expand...

I believe the G0439 should really be billed by a PCP. There is an extensive physical exam involved that I believe goes beyond the standard GYN exam. Maybe I am wrong?
 
G0101/q0091

I have noticed that G0101 pays with dx V70.0 and if a pap smear is performed, then Q0091 is billed and dx is V72.31.

NOTE: If a pap smear is billed within the 2 years, then the patient needs to be presented as high risk to get the claim paid.

Hope this helps.
 
My bills have NEVER been paid using the V72.31 with the G0101. Might depend on where you are but we always bill G0101 with V15.89. According to their site, that's the code to use. If you do the pap, you have to bill with V76.2. Medicare usually pays them in full and also make sure you get that ABN if the patient is early. Medicare is anal and has to have it a year or two to the DAY.
 
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