Wiki Preventive and Pap Smear

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jortego

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Hi, I am new to OB/GYN coding. If patients comes in for their annual, can we charge for the preventive code and the Pap Smear collection? We have a Clia Wavier if you need to know that. If so, what CPT codes should be billed for the Pap?
Thanks in advance for your help.
 
I code for Family Practice and we bill the preventitive CPT according to age V72.31, then we bill out the pap with 88175 with a DX of V76.2. If this is a Medicare patient then you have to use the "Q" code for the collection of.
 
OBGYN visit

I work at a family clinic and we have been billing for 88175 for the pap collection as well. Our hospital then sends the lab to be read at Ameripath. Our Blue Cross is the only insurance having a problem with this because Ameripath is billing for the same code and Ameripath says we should be billing with a different code. Blue Cross is saying that we bill for the same code but we put a 26 modifier on our 88175 and Ameripath puts a TC modifier on their 88175. However, Ameripath disagrees and refuses to file corrected claims. Any feedback would be greatly appreciated. thanks.
 
leslie

We are also clia waived. We bill 88175 with a 90 modifier as our local hospital performs the tests. There are certain insurance companies that do not allow us to bill for labs, bcbs is not one of them. The ones that we have the hospital bill is united healthcare, tricare, medicare and medicaid.
 
We bill the preventative code and if they have a pap, we code 99000 for the specimen collection. If they are Medicare, we code G0101 and Q0091. We do not use 88175 - the 8xxxx codes are for the labs to bill for their services. We do not do the test - just the collection. Unless you are actually doing the test I would not use any codes from 8xxxx, with or without the 26 or TC modifier.
 
the 88175 is not a code for PAP collection.. It is a code for the lab to use not the physician office. The is no code for the collection of the PAP, a pap is either part of the E&M or for Mcare and others that accept the code it is a Q0091 for a preventive a non preventive is part of the E&M
 
Pap Collection

The following codes are valid for BCBSMS wellness program for a pap smear:

88141-88143
88147
88148
88150
88152-88154
88164-88167
88174
88175
G0123
G0124
G0141
G0143
G0144
G0145
G0147
G0148:pap smear

I am not a coder (yet). So, any help is greatly appreciated. I am getting inconsistent responses over the hospitals in our corporation. The E/M visits are based on age (that we have to file for the wellness visits). So, it is not like we can increase any value to compensate for the collection. So, I am taking it that if we do a pap, then we can not bill for it separately unless it is Medicare?
 
The 88xxx codes are for the lab only as for the provider the pap is the exam and the charge cannot be elevated due to its collection
 
I am in agreement with Debbie. You cannot bill the 88175 code as that is the code that the lab would use to bill the analyzing of the pap sample. For most payors we bill only the preventative visit. Some payors will pay the Q0091, but not many. For MCR we bill the preventative visit, G0101 (there are 10 bullet points to this proceudre code in the MCR policy and as long as the physcian performs 7 of these you can bill G010. A Pap does NOT have to be done if 7 other bullets are performed). When a Pap is done we bill the Q0091 as well. However you have to split bill the preventative visit from the Pap smear code. For example if you charge $180.00 for a yearly code any other payor then MCR you cannot charge $180.00 to MCR as well as the as the dollar amount for G0101. If the charge for
G1010 is $45.00 you have to minus that total from the MCR preventative code cost. Therefore the cost for the MCR preventative visit would be $135.00.
 
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