Wiki G0101/Q0091 help

[TLC]

I need some clarification on G0101 and Q0091. Can this be billed to all insurances or is it just to be used for Medicare pts? If a patient just comes in for a pap we use the G0101 our new billing service said we should be just using the Q0091.Which is my understanding is only for the "obtaining,preparing" of the pap not the actual pap itself which I believe would be G0101. Can we use both of the codes together? and can they be used on insurances other than Medicare? Also our OBGYN doctors are using the 9939x codes for well woman exams. But than they see their primary doctor for their physicals and charge they charge a 9939x code. Should the OBGYN's just be using G0101 if only a pap is done and a E/M code if there is another dx to go with it? Sorry such a long question I hope to get some feedback.

 

[rthames052006]

I need some clarification on G0101 and Q0091. Can this be billed to all insurances or is it just to be used for Medicare pts? If a patient just comes in for a pap we use the G0101 our new billing service said we should be just using the Q0091.Which is my understanding is only for the "obtaining,preparing" of the pap not the actual pap itself which I believe would be G0101. Can we use both of the codes together? and can they be used on insurances other than Medicare? Also our OBGYN doctors are using the 9939x codes for well woman exams. But than they see their primary doctor for their physicals and charge they charge a 9939x code. Should the OBGYN's just be using G0101 if only a pap is done and a E/M code if there is another dx to go with it? Sorry such a long question I hope to get some feedback.

Best thing for you to do is check carrier medical policies. Some carriers do allow the G0101 and there are a few who also allow the Q0091.

 

[01065679]

Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

I need some clarification on G0101 and Q0091. Can this be billed to all insurances or is it just to be used for Medicare pts? If a patient just comes in for a pap we use the G0101 our new billing service said we should be just using the Q0091.Which is my understanding is only for the "obtaining,preparing" of the pap not the actual pap itself which I believe would be G0101. Can we use both of the codes together? and can they be used on insurances other than Medicare? Also our OBGYN doctors are using the 9939x codes for well woman exams. But than they see their primary doctor for their physicals and charge they charge a 9939x code. Should the OBGYN's just be using G0101 if only a pap is done and a E/M code if there is another dx to go with it? Sorry such a long question I hope to get some feedback.

This came from a BC/BS policy...
Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

We would like to take this opportunity to remind providers that obtaining a Pap smear is integral to the office visit, including both preventive and routine office visits. Separate reimbursement is not allowed for HCPCS code Q0091.

According to the American Congress of Obstetricians and Gynecologists, code Q0091 should not be reported to non-Medicare payers for Pap smear collection, as the collection of a Pap smear is included in the E&M or preventive service.

The Q0091 code was developed by Medicare for the exclusive purpose of reporting services provided to Medicare patients. Providers should report this code to Medicare only for the collection of screening Pap smears for Medicare patients.

 

[jdibble]

When a Medicare patient sees their OBGYN for a Well Woman visit, that is code G0101. The Well Woman visit includes examination of the breasts and documentation of a at least 7 of 11 elements of a pelvic exam. If the doctor does a pap, then you would also code Q0091 which is for the collection. These are 2 separate codes for different reasons and for Medicare are billed together. Medicare will not reimburse for an E/M code for a well visit.

Keep in mind that you need to follow Medicare guidelines as far as the length of time in between paps as far as reimbusement - so you need to have the patient sign an ABN as a routine pap is every 2 years.

For non-medicare patients you would use an E/M well visit code - the pap is included in this code and is not billed separately. The patient's benefits usually allow for a well woman visit as well as an annual exam so using the same code hasn't been an issue in the past for us.

Hope this helps!