Wiki G0101/Q0091/S0610/S0612 annual exams!

[lsilbaugh]

Hello I am looking for some clarification on billing these Medicare/blue codes.


Do we add these codes onto the annual exam cpts? (ex:99394-99397) or if its a Medicare patient we can bill G0101 and Q0091 or BCBS s0610/s0610 by itself?

Clear guidelines on this would be so helpful. Thank you!

 

[nielynco]

Hello I am looking for some clarification on billing these Medicare/blue codes.


Do we add these codes onto the annual exam cpts? (ex:99394-99397) or if its a Medicare patient we can bill G0101 and Q0091 or BCBS s0610/s0610 by itself?

Clear guidelines on this would be so helpful. Thank you!

I created the attached document with regard to billing Medicare which you might find helpful. It includes different scenarios, use of the codes (both CPT and ICD10) and references in case anyone wants to know "where does it say that." I have updated it to reflect rules in effect in 2024.

 

[lsilbaugh]

I created the attached document with regard to billing Medicare which you might find helpful. It includes different scenarios, use of the codes (both CPT and ICD10) and references in case anyone wants to know "where does it say that." I have updated it to reflect rules in effect in 2024.

thank you!

 

[beckysblouin]

I created the attached document with regard to billing Medicare which you might find helpful. It includes different scenarios, use of the codes (both CPT and ICD10) and references in case anyone wants to know "where does it say that." I have updated it to reflect rules in effect in 2024.

SO! nice of you to share this document / this work - Thank you!!!

 

[bbernal]

I am new to Gynecology - I have been searching and searching for this information. Your guide is EXCELLENT!!!! May I use it for my practice? I see it is copywritten.
Barbara

 

[bbernal]

I do have a question as I am trying to digest this information - I see question #2 is "is the patient being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the Medicare covered year?" Shouldn't there be a scenario #4 which would say " is the patient being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the Medicare NON-COVERED year? or do I assume that the answer of "NO" to question 2 means " the patient is being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the NON-COVERED year"

 

[nielynco]

I am new to Gynecology - I have been searching and searching for this information. Your guide is EXCELLENT!!!! May I use it for my practice? I see it is copywritten.
Barbara

Yes you may use it. I copyrighted it as I did the work in creating it while I was doing consulting work.

 

[nielynco]

I do have a question as I am trying to digest this information - I see question #2 is "is the patient being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the Medicare covered year?" Shouldn't there be a scenario #4 which would say " is the patient being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the Medicare NON-COVERED year? or do I assume that the answer of "NO" to question 2 means " the patient is being seen for her complete annual well-woman exam including the pelvic/breast exam and Pap Smear collection in the NON-COVERED year"

Correct. If the answer is no it means you bill only the preventive service to the patient and nothing to Medicare in the non-covered year.

 

[bbernal]

Do you know of any consultant that would be able to do an in-service for my practice on Medicare billing for annuals, ABN's etc - I am afraid we are not be billing correctly and I want to get this corrected as soon as possible. Any suggestions would be much appreciated.

 

[nielynco]

Do you know of any consultant that would be able to do an in-service for my practice on Medicare billing for annuals, ABN's etc - I am afraid we are not be billing correctly and I want to get this corrected as soon as possible. Any suggestions would be much appreciated.

If you use the guide I provided, you should do fine - then only adapt it for your practice protocols when seeing patients for annual exams. I don't know of anyone off hand who is in your area who could do an in-service, but you might want to contact your local AAPC chapter to see if they have anyone who can or can make a recommendation. I know there is one in Yardley/Levittown and the contact info is listed below.

Michele Hines, CPC President

mhines62@gmail.com (215) 478-5125

 

[bbernal]

I just had more questions about your document. Thank you.