Question Billling annual preventative with pap on different day

mgarcia400

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Can anyone please verify the correct way to bill a pap that was part of annual preventative but was done on a different date of service?
A patients comes in we bill 99396 with Z00.00, insurance pays visit. Patient decides to come back week later for PAP. We bill 99213. Insurance applies visit to deductible. You can not bill 99396 twice within a week from the same place of service, correct?

Clarification is appreciated.
 

njycarter17

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We have a lot of patients that come in for their annual physical and pap on different date (similar to your situation) in our family care offices. If they are seen for annual physical we bill 9939X with dx Z00.00 and pap we bill 9939X with dx Z01.419. Hopefully that helps you out some!
 

mgarcia400

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We have a lot of patients that come in for their annual physical and pap on different date (similar to your situation) in our family care offices. If they are seen for annual physical we bill 9939X with dx Z00.00 and pap we bill 9939X with dx Z01.419. Hopefully that helps you out some!
You haven't had any problems with getting 9939X paid both times with only about a week apart with same place of service? We have trouble getting it paid when billed the second time for the PAP.
 

csperoni

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If the second visit was in fact another preventative, that is how it should be coded.
Each insurance seems to have their own internal policy regarding 2 preventative visits. Some pay both with the appropriate Z codes, no questions asked. Some will initially deny the 2nd and pay after an appeal explaining is sent. Some will absolutely not pay 2 preventative regardless of how many letters and appeals are sent if it is simply not part of the patient's benefit.
I realize it may be more common in rural areas, but around me, you would be hard pressed to find a PCP willing to do a PAP and well woman exam. A preventative well woman exam is more than just a PAP and may have some overlapping work, but not all overlapping work of a preventative annual physical. Well woman exams will typically include a breast exam, discussion of birth control or reproductive plans, sometimes a discussion of sexual practices to identify high risk behaviors that may warrant additional testing. A preventative annual physical will include items and testing that are not discussed during a well woman exam. If the clinician chooses to provide all those services at one visit, then 2 preventative exams should not be coded.
 

mgarcia400

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If the second visit was in fact another preventative, that is how it should be coded.
Each insurance seems to have their own internal policy regarding 2 preventative visits. Some pay both with the appropriate Z codes, no questions asked. Some will initially deny the 2nd and pay after an appeal explaining is sent. Some will absolutely not pay 2 preventative regardless of how many letters and appeals are sent if it is simply not part of the patient's benefit.
I realize it may be more common in rural areas, but around me, you would be hard pressed to find a PCP willing to do a PAP and well woman exam. A preventative well woman exam is more than just a PAP and may have some overlapping work, but not all overlapping work of a preventative annual physical. Well woman exams will typically include a breast exam, discussion of birth control or reproductive plans, sometimes a discussion of sexual practices to identify high risk behaviors that may warrant additional testing. A preventative annual physical will include items and testing that are not discussed during a well woman exam. If the clinician chooses to provide all those services at one visit, then 2 preventative exams should not be coded.
Thank you for response! We at times have patients come in for their preventative visit but will not have their PAP done on same day ie. due to menstruation and return the following week to have it done. In my area it is very common to have this done with their PCP at a family practice vs going to their gynecologists'.
 
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