New to GYN Billing

werner03

Networker
Messages
63
Location
Oak Brook, IL
Best answers
0
I am seeing that is a PAP was done during the well women exam then the pap is not covered does that include the HPV test that was done?
Since there is no billing for the PAP can we bill Q0091? and what about U\A is that included in the exam?

Thanks for the help.

Katie
 

csperoni

True Blue
Messages
569
Location
Selden
Best answers
2
When we do a PAP, we bill Q0091. MANY carriers will not pay separately for Q0091 with E/M service. But we do bill it, as some carriers will pay. Those that deny, we write off as contractual adjustment. Same for U/A. It is additional work/resources and in my opinion, should be paid additional, but many carriers do bundle.
Regarding your question about HPV test. HPV test is something done by the laboratory to further test the specimen you already collected for the PAP. The lab is likely billing for that additional service, but since the provider is not doing anything, there is nothing to bill. Think of it as a provider who draws blood in the office. You bill 36415 whether you order 1 blood test or 100 blood tests.
Hope that helps.
 

werner03

Networker
Messages
63
Location
Oak Brook, IL
Best answers
0
Thank you for the reply, I do see that there is a split of the HPV test from our insurance carrier for the TC or 26, so in that case I can bill our part and they can get paid for taking the test. Thanks for the clarification on what I had been thinking appreciate it!
 

ELBrock

Networker
Messages
54
Best answers
0
Hello! According to ACOG (American College of Obstetricians and Gynecologists), the Pap smear is included with the pelvic exam during the E/M. Q0091 was created for Medicare, because they do not cover the annual codes as billed with Preventive Medicine services codes (99281-99397). You wouldn’t bill the annual preventive code and the Q0091, because those codes include the pap smear already. If the patient presents for a screening Pap smear Outside of their annual, you would want to look up the payer guidelines to see if they cover Q0091 in that instance. Most do not, and so the Pap smear is not billable outside of the E/M code. If the Pap smear is diagnostic (due to a reported problem) then it is included in the E/M still.
 
Messages
356
Location
Clovis, CA
Best answers
0
I am seeing that is a PAP was done during the well women exam then the pap is not covered does that include the HPV test that was done?
Since there is no billing for the PAP can we bill Q0091? and what about U\A is that included in the exam?

Thanks for the help.

Katie
The pap is covered; it is included in the work of the well woman exam. It's not paid separately because you're already being paid for it.
 
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