Home Forums Discussions Coding and Billing Billing for Pap Smear

Hey Guys,

I have a question. When i try to bill for a Pap Smear (Q0091) with an office a preventative visit (99396) i get this error:

Procedure Q0091 unbundles to Hx Procedure 99396,(PERIODIC PREVENTIVE MED EST PATIENT AGE 40-64YRS) on Visit #339, Line #1. The payer may deny this procedure relationship.

I guess i am wondering how anyone else bills for a pap smear with a preventive office visit?

Thanks so much!

Ben

Ben, NCCI considers Q0091 to be a column one code to the primary procedure 99396, meaning one service inherently includes the other. Assuming you are familiar with the code edits, I cannot think of a way to bill for the Q0091 code with the 99396. However, if you can justify an additional E&M code, eg: while performing the no diagnosis physical you find PID, you can justify performing the pelvic exam but billing using a focused exam, say 99212, billing the 99396 w V70.0 and the 99212-25 w dx for the PID.

Insurance sucks the life out of revenue, so I try to be as aggressive as possible whenever permissible. Hope this helps some, I've received a lot of help from forums so I want to be able to contribute back.

GDN

Thank you so much for your response!

We use G0101 for pap exams with preventive care exams and use ICD-9 code V76.2 for low risk every 24 months or V15.89 for high risk every 12 months pap exam and still use V70.0 with the preventative care code (99394-99397).

Leah, sounds like you're on-to-something. The G0101 q 24 or q 12 months depending on the risk sounds like it's straight out of CMS playbook, as does the G code, but then how do you get a 9939x through Medicare, these exams are excluded by statute?

Maybe old dogs can learn new tricks, I'm all ears.

GDN

Interesting how someone always wants to pass a law telling physicians what they must do for free. In one recent Medicare law, it demands that physicians must complete all forms at the physical for no additional charge. I think in NJ physicians cannot charge for drawing blood. You cannot charge for a Pelvic exam/pap smear--thats part of the routine physical (no it ain't).

For medicare our medical biller uses the new code effective this year for physical exams which is G0438.

Thanks Leah, so in reality, you are using G0101 with G0438. What about G0101 with 99396, that was the question of the original post? I am stilling holding hope that you've got a trick up your sleeve.
GDNicoll

Yes, our medical biller has been using G0101 with 9939x. I sent her an email to clarify if this is indeed the correct way to bill for non-medicare patients. As soon as I hear back from her I will let you know.

Ok so i was going through the health care reform this i received from BCBS and i found P3000 and P3001 as one of the items that pays with no hcost sharing for the patient. Does anyone know how this works or how it differs from Q0091?

P3000 - Screen pap by tech w md supv (BCBS pays $9.81)
P3001 - Screening pap smear by phys (BCBS pays $41.43)

This might also be of help for others:
https://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

Here is some more info:

https://www.highmarkbcbswv.com/medadvpolicy/L-1-002.html

Age,

Looking the codes you mentioned, P3000 and P3001, these appear to be the codes for the pathology services performed by a pathology technologist and doctor respectively.

GNicoll

I have confirmed with our medical biller. We are using 9938x or 9939x with G0101 for the pelvic exam part and then Q0091 for obtaining the pap smear to go to the lab.

I believe you Leah but don't believe that your biller is coding based on NCC edits, but thank you for checking. I guess if the payers are okay with it you'd be wrong to not pursue it.

Are they attaching a 25 to the 993xx or a 59 to the alpha codes?

GNicoll