Papsmear only commercial ins

mconnolly

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Can someone please tell me how to code a claim if the patient only came in for a papsmear and an HIV test? Pt has Aetna ins, do I bill 99213 or can I bill Q0091 or both? I understand the code 88150 is for the lab, correct?
 

btadlock1

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Can someone please tell me how to code a claim if the patient only came in for a papsmear and an HIV test? Pt has Aetna ins, do I bill 99213 or can I bill Q0091 or both? I understand the code 88150 is for the lab, correct?
If the patient didn't have a complaint, then you can't bill a problem-oriented E/M (eg, 99213). You'd need a preventive code, instead (eg, 9939X). If there was a complaint, then you can report a 99213 in addition to the labs - just make sure you list the correct diagnosis codes on each procedure.

Aetna doesn't cover Q0091, to my knowledge (most commercial payers don't, actually.)
Here's their clinical policy bulletin (coverage criteria) on it, complete with a list of covered CPT, HCPCS, and ICD-9 codes:
http://www.aetna.com/cpb/medical/data/400_499/0443.html

If you had to send the sample out (which I assume to be the case, since you mentioned the Q0091), you may be able to report a code from the lab section (such as 88150), with a 90 modifier on it, but you should check with your provider relations rep to be sure. Hope that helps! ;)
 
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