Wiki G0101 & Q0091 Denials

[cgreen611]

I am seeing many denials from Medicare and Medicare Advantage Plans for HCPCS codes G0101-25 & Q0091 stating the modifier is inconsistent with the procedure/Required modifier missing.
We are billing the following:
G0101-25
Q0091
DX: V72.31

Help please!

Also, if you can tell me where you get your information so I can forward it to my internal consultant/educator I would appreciate it.

 

[msr1984]

The modifier is inappropriate, modifier -25 is for E/M services, you put a -25 on a procedure. The denial is correct, remove the modifier and resubmit based on the carrier's requirement. Also, Medicare wants the V76.2-Screening for malignant neoplasm of cervix.

 

[katemae84]

We use the -25 modifier on the G0101 with the V72.31 dx and use V76.2 for the Q0091. We haven't gotten any rejections back for it.

 

[mitchellde]

We use the -25 modifier on the G0101 with the V72.31 dx and use V76.2 for the Q0091. We haven't gotten any rejections back for it.

V72.31 excludes V76.2 per the code book. They cannot be coded together. For well woman you use only the V72.31. I have never used the 25 modifier. However the denial may be due to timing. If you perform the well woman without the appropriate number of days since the last one then it will be denied.

 

[cgreen611]

We were finally able to get an answer from Medicare as of 12/8/2014 Medicare no longer requires or accepts the 25 modifier on G0101 when performed with Q0091. There is no bulletin documenting this change only a payor rep by phone. At one time we were told the 25 was required to get paid. Thanks for your responses!