A patient came in for her well woman exam but did not do a pelvic exam or pap smear. Had she had the pelvic i know we would bill the G0101. But what would it be in this case? Would this be an E/M?
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Wiki Well woman exam billed to Medicare but no pelvic exam/pap
- Thread starter cgarciamck87@gmail.com
- Start date
Pam Warren
True Blue
99397 is statutorily excluded from Medicare Coverage, per federal guidelines. As such, no ABN is required and you may balance bill the patient, which should be evident on your remittance advice. A good rule of thumb is to never provide these for Medicare recipients; instead consider Annual Wellness Visits, addressing chronic conditions and billing an E&M with a comprehensive exam, or billing only pap/breast/pelvic. Medicare has an excellent preventive service guide that may be helpful for you. https://www.medicare.gov/coverage/preventive-screening-services
If you have a large Medicare population, you will need to wrap your head around Medicare guidance, otherwise you stand to lose revenue (and anger your patients).
If you have a large Medicare population, you will need to wrap your head around Medicare guidance, otherwise you stand to lose revenue (and anger your patients).
Pam Warren
True Blue
9938x or 9939x. Preventive visits (basically the well exam). E&Ms are only for visits with chief complaints/problems/illnesses/injuries.
G0101 and Q0091 are Medicare HCPCS codes for Pap/Breast/Pelvic. Some commercial payers will cover them.
G0101 and Q0091 are Medicare HCPCS codes for Pap/Breast/Pelvic. Some commercial payers will cover them.
So this particular patient has a medicare advantage plan. 99397 was billed to them but it was denied. "Statutorily excluded service". Would this mean then patient is financially responsible?
Yes, the patient would be responsible for services excluded from her coverage. You may consider waiving this from a customer service perspective if your practice didn't let her know in advance. Not required, but something to consider. And use it as a learning experience moving forward to not perform services you know will not be covered without informing patient in advance and collecting payment.
Thank you both for the information. This has helped a lot and will be speaking with providers.