cgarciamck87@gmail.com
Contributor
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?
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?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.
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.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?