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Marilyn Posted Tue 01st of October, 2013 00:02:17 AM

Performed Physical and claim billed out as:
99395 Denied (service is considered to be part of an allowance aknowledged on this or previous claim)
Q0091 Denied
G0101 Paid

Is there suppose to be a modifier somewhere in order for claim to be pd.?

SuperCoder Answered Tue 01st of October, 2013 00:56:09 AM

If this is a preventive encounter then there is no reason for the ov. Just because a patient has chronic issues, to discuss these issue and order tests or renew med is all part of the preventive. While the dx codes may be listed in addition to the preventive dx code you cannot just charge an ov in addition. If the patient has a new symtomatic issue that is discussed or investigated at the same time as the preventive then you may charge an ov. But if the patient requested and presented for a preventive only then you have no reason to charge an ov charge.

99395-96-97 Preventative codes (including 99385-86-87) and etc. INCLUDE G0101 and Q0091.
G0101 and Q0091 are to be used for carriers that do not cover preventative care.
Q0091 includes G0101 because by definition its a pelvic Ca screening and collection of PAP.

However, all Preventative codes (99385-6-7 99395-6-7) Include Pap Q0091 and breast exam G0101.

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