Wiki Medicare Annual Wellness Visit and additional Well Woman Exam

[jorellana42]

Hello, fellow coders:

One of my providers performed an AWV and a separate well woman exam on two different dates of service. Since both were preventive, triggering use of G0468 (we're an FQHC), Medicare paid the first well woman visit, but denied the AWV. My billing manager wants the provider to change the CPT code to an office visit (G0467) to get it paid, but the provider coded both correctly as preventive, with SOAP notes corroborating the coding. Has anyone had any luck in getting both an AWV and a well woman visit paid by Medicare?

Thanks,

 

[elittleton87]

Hello,

I work for a RHC so our billing requirements are similar. For Women's Well exams we use G0101 (pelvic and breast exam) and Q0091 if a pap was done. If the provider wound up treating the patient for something as well we will also bill an office visit.

 

[jorellana42]

Thanks so much for your help! We're going to try this and see how it goes

 

[ELBrock]

Hello! I also work for an FQHC, and we don't bill Medicare for Preventive Visits. If a provider codes a preventative medicine cpt, and it's a Medicare patient, I review the documentation to verify it qualifies for a G0101/Q0091 and then bill those out for payment.