mconnolly
Guest
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 this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Papsmear only commercial ins
- Thread starter mconnolly
- Start date
btadlock1
Guest
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!
