Wiki Medicare Annuals

[melheffley]

I have a question reguarding our Traditional Medicare patients and their annual exams. I understand that Medicare will only allow 1 pelvic/breast & pap (G0101 & Q0091) per 2 years unless the patient is considered "high risk". Our physicians feel that it is important to follow up with our patients on a yearly basis. They perform a pelvic/breast exam as well as a Hemmocult test each year. If our patient does not qualify as "high risk" by Medicare, how should we bill the off year? Would we simply be billing a 99214 (or appropriated e/m level) and G0328? This is how the office previously was billing for these services. I am new to this office as well as the billing/coding for OB/GYN. I just want to make sure we are doing things appropriatly.

 

[tlc45801]

We still bill for the G0101 and Q0091 (if smear done) but get an ABN signed. The patient is responsible since it is the "off" year by Medicare guidelines.