Wiki pap verses preventive visit

[Charlotte44]

A patient comes in for her yearly pap. We bill with a preventive code and the diagnosis for the pap. A few weeks later the patient comes in for her yearly preventive visit to review yearly lab work that was done. We bill with a preventive code with the preventive diagnosis code. Is the patient's insurance going to cover both since they both were billed with the same preventive CPT code or is the pt. going to receive a bill for one? What about it the pt. has their preventive well visit here and their pap at the OBGYNs? Will they both be covered?

 

[Akulo]

A patient comes in for her yearly pap. We bill with a preventive code and the diagnosis for the pap. A few weeks later the patient comes in for her yearly preventive visit to review yearly lab work that was done. We bill with a preventive code with the preventive diagnosis code. Is the patient's insurance going to cover both since they both were billed with the same preventive CPT code or is the pt. going to receive a bill for one? What about it the pt. has their preventive well visit here and their pap at the OBGYNs? Will they both be covered?

I don't think you're suppose to bill a preventive visit for just the pap collection alone.

Annual physical codes have a lot of work involved. Pap smear collection is included with the other things done during an annual physical visit , including breast exams, getting blood work, urine test, screenings and such. Pap smear collection alone is just using a dilator and taking a swab and sending it to the lab, so that amount of work alone does not equate to everything else that needs to be done to qualify for billing a annual physical code.

Some payers might recognize and pay the code Q0091 (pap smear collection). The code was meant for medicare patients only since they don't cover Annual Physicals, so they came up with this code to make up for the pap smear collection service which would have been included in the annual physical codes.

I believe women are allowed two annual physicals per a year, one for PCP and one for GYN, so you're possibly wasting one of the patient's annual physical allowances or the payer would probably ask for medical documentation since you're billing two preventive codes in such short intervals.

If you need to bill for the pap smear alone and if Q0091 is not covered, I think you could bill a regular office visit E/M code, that's probably only if the patient came to the office that resulted for the need for a pap smear, like the patient's had contact with genital warts for example.. since you need to have a chief complaint to bill an office visit.

 

[lorrieb23]

In my experience patients are only allowed 1 preventative visit per year, female or male. We have well woman claims (ex: 99396) denied all the time because the PCP billed the annual first.