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Family Practice

sstone

Contributor
Messages
16
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0
pap screen/handling

Hi, I've just recently started billing for a family practice clinic in NH and I'm not familiar with how some procedures need to be billed. For codes 99000 billed with Q0091, it looks like most insurance don't pay for this. They are denied stating they are incuded in another service. They've been billed in the past with diag V76.2. I would appreciate any information/help with this. :confused:

Thanks,
Sharon
 
Last edited:

mcpalmeter

Guru
Local Chapter Officer
Messages
192
Location
Jacksonville, Florida - 90417
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0
Sharon,

According to the definition of Q0091 in Level 2 HCPCs, it states, "obtaining, preparing and conveyance of cervical or vaginal smear to laboratory." As such, one cannot bill 99000 in addition to Q0091 because 99000 is in essence a code for conveyance of a specimen from an office to a lab and that is already included in the definition of Q0091.

Hope this helps.

Maryann Palmeter, CPC :)
 

sstone

Contributor
Messages
16
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0
Thanks Maryann,

Yes, it does help. It makes me feel like I know what I'm doing, but why would a payor reject saying it's included when CCI edits say it can be billed with other codes?

Sharon Stone, CPC
 

Cottrell

Guest
Messages
103
Location
north seattle wa
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0
paps

Some private payors won't pay for the Q0091. They consider it included in the exam, so does ACOG. Medicare does pay for the Q0091 in addition to the exam code.


Wendy
 

Jackie Stack

Networker
Messages
52
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0
Medicare will pay for the Q0091 once every 24 months. Some private payers will also pay this but the majority of them will bundle this services. You need to check with each of you payers to see if they will pay for this in addition to your physical codes.
 

jhack

Networker
Messages
49
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0
Q0091 And 90000

What if the Dr is doing a pap and handling Q0091 and other labs with handing of 99000. Are both handling fees able to be billed in this situation?
Any help is appreciated.:)
 

daniel

True Blue
Messages
521
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0
Just some extra input.

I work for a multi-specialty practice. The bulk of the services I go through is Family Practice.

I suggest you always use Q0091 for collection of the pap smear vs. 99000. The reimbusement is more frequent then 99000 handling charge. Plus the reimbursment is higher. I've seen a range payment for Q0091 between 30.00-45.00 dollars. Which isn't bad.

Regarding if you can bill Q0091 and 99000 at the same time. As long as there not for the same services. Like you mentioned. Just be sure to link the Dx's correctly. No guarentee on payment. But you can bill both. Just a side note, I've seen 99000 get kick back a lot.

Respectfully
Daniel, cpc
 
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