Wiki Medicare Preventive Exam

[tracylc10]

I am so confused on how a Medicare Preventive Female Exam is properly coded. If a patient just has Medicare, how should a preventive female exam be coded?

Secondly, if they have a secondary insurance, what is the proper way to code the visit.

Third, what if the patient insists on coming in every year? How should the off year be coded?


From what I understand, you would code G0101-GA, Q0091-GA and the appropriate preventive care code with modifier GY.


Please help me understand the proper way to code this...feeling lost...

 

[Dhyatt61]

Pelvic exam

Yes, I agree that G0101-GA is the correct code for a pelvic exam/cancer screening for Medicare beneficiary. IF the patient also has a secondary insurance, you
still need to report the G0101-GA to Medicare. What I have done in this situation is report this same code to the secondary insurance as I do not believe you
are allowed to change the coding for secondary ins. There will not be a Medicare copay or deductible amount for patient as this is a screening (copay and deductible will
not be applied).

Medicare publishes a very informative article on this subject:

https://www.cms.gov/Outreach-and-Ed...ownloads/Screening-PapPelvic-Examinations.pdf

Or you can just search cms.gov and then in their search bar, enter G0101 and you will find this article. I am not sure about also billing the Q0091 but this
article addresses it.

Diane

 

[tracylc10]

Yes, I agree that G0101-GA is the correct code for a pelvic exam/cancer screening for Medicare beneficiary. IF the patient also has a secondary insurance, you
still need to report the G0101-GA to Medicare. What I have done in this situation is report this same code to the secondary insurance as I do not believe you
are allowed to change the coding for secondary ins. There will not be a Medicare copay or deductible amount for patient as this is a screening (copay and deductible will
not be applied).

Medicare publishes a very informative article on this subject:

https://www.cms.gov/Outreach-and-Ed...ownloads/Screening-PapPelvic-Examinations.pdf

Or you can just search cms.gov and then in their search bar, enter G0101 and you will find this article. I am not sure about also billing the Q0091 but this
article addresses it.

Diane

Thank you Diane. I think the part that is the most confusing to me is when the patient insists on coming in every year for an "annual exam". How would the off year be coded? My MD's want to code the off year with a regular office visit E&M. I am sure that this is NOT how it should be coded.


Thanks again,
Tracy