jen9471
Guest
Hi! I work with a multi speciality practice and I am running across an issue where our Aetna patients are getting denied for preventative services.
What happens is our OB/Gyn practice is billing for a yearly preventative visit w/ a obtaining of pap (99395 Q0091 w/ V72.31) and than a month or so later the patient's pcp office, which is part of our practice, is billing for a preventative (99395 w/ V70.0). It hits Aetna and the second claim done by the PCP is being denied as Max Benefits. It's my understanding that the OB/GYN is only obtaining the patient's yearly pap because the patient is deferring it by the pcp's office. I have been told in that case that the OB/GYN would bill a 99211-5 with the Q0091 w/ diag V72.31. The PCP should than bill 99395-7 with V70.0. Is this correct? I need to know if this is a coding or an education issue. Any help would be appreciated. Thanks
What happens is our OB/Gyn practice is billing for a yearly preventative visit w/ a obtaining of pap (99395 Q0091 w/ V72.31) and than a month or so later the patient's pcp office, which is part of our practice, is billing for a preventative (99395 w/ V70.0). It hits Aetna and the second claim done by the PCP is being denied as Max Benefits. It's my understanding that the OB/GYN is only obtaining the patient's yearly pap because the patient is deferring it by the pcp's office. I have been told in that case that the OB/GYN would bill a 99211-5 with the Q0091 w/ diag V72.31. The PCP should than bill 99395-7 with V70.0. Is this correct? I need to know if this is a coding or an education issue. Any help would be appreciated. Thanks