Break Out Well-Woman-Care Visits For Better Reimbursements

A little known fact about well-woman care is that in many cases, you can break out the breast exam and pap smear and realize a reimbursement for both procedures if the patient is covered by Medicare.

If the physician provides a complete well-woman exam for a Medicare patient, you should report G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When the physician also obtains a Pap smear, use Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)and this will enable your practice to realize a reimbursement for both services.

Just make sure that you have the necessary medical necessity and documentation to back up the breaking out of both services and in most cases you must attach modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). An important thing to remember, for Medicare patients at normal risk, you can report a Pap smear only once every two years. The diagnoses your physician will use in these cases include V72.31 (Routine gynecological examination), V76.2 (Special screening for malignant neoplasms; cervix) and V76.47 (… other sites; vagina),

Using these techniques, you should be able to increase your Medicare coverage of this common service to your medical billing claims and see a better reimbursement when you perform this service.

View all Articles by: Melissa Clark, CCS-P