Pap Smear-aspect of coding

N70QW

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I am new to this aspect of coding so be kind, but our gyn doc will do an annual pap and pelvic on the patients, he collects the smear, prepares the slide then sends it off to an outside lab. Do we bill the patient the 88175 or just the collection of specimen? Just not sure. We have been getting some denials from insurance stating they have already paid that code. I assume they must have paid the lab because I belive they use the same CPT code.
thanks
 

rthames052006

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You would just be billing the collection of the specimen, the lab will bill for the other part.






I am new to this aspect of coding so be kind, but our gyn doc will do an annual pap and pelvic on the patients, he collects the smear, prepares the slide then sends it off to an outside lab. Do we bill the patient the 88175 or just the collection of specimen? Just not sure. We have been getting some denials from insurance stating they have already paid that code. I assume they must have paid the lab because I belive they use the same CPT code.
thanks
 

carafry

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it depends

It depends on your contract with the lab and the insurance plan. If you are set up so that the lab bills and is paid by the ins co, you would bill only for the physician's services of collecting the pap. If the plan is set up so that the lab bills you and you pay the lab, you should bill the ins co for the pathology portion as well. If you end up billing the pap, double check your pap codes. Code 88175 is for a pap that is run by an automated system and then needs to be re-screened manually by a physician. Our group uses 88164 for Bethesda method and 88142 for thin prep. Are you getting denials from all of the plans or only some? See if you can talk to someone involved with your lab contracts. Worst case scenario, track which plans you are getting denials from, make sure the lab is actually billing for the pap and stop sending pathology codes to those payors (last resort only - better always to find accurate first-hand information). Hope this helped and wasn't too confusing.
 
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