Billing preventive services with problem-oriented E&M services
G0101 (pelvic and breast exam) and Q0091 (obtaining and preparing a Pap test for the lab) shouldn’t be reported with an E&M service (99201-99215) if the E&M service better describes the service rendered. Priority Health does not reimburse separately for G0101 or Q0091 when they are performed for indicated purposes on the same date as a problem-oriented E&M service. Breast and pelvic exams, including obtaining, preparing and conveying a Pap smear, are considered components of an exam and medical decision-making.
If these codes are reported solely for the purpose of an unrelated screening service, Q0091 and G0101 may be separately reimbursed in addition to the problem oriented E&M service.
- Documentation must clearly support a significant, separately identifiable service.
- Any reconsideration of denied services will require a review of medical documentation.
Please see the
Procedures & Services section of the Provider Manual.
Topics: Billing
