Wiki preventive elements split

[stephmescher]

Hello,
Wondering if someone could give guidance when it comes to patients who have their annual physical with a male physician but prefer to have a female do the pap/breast exam on a different day- are we able to bill the Q0091 for the pap smear on the second visit or could we do a 99212?
Thanks in advance
Steph

 

[nielynco]

Hello,
Wondering if someone could give guidance when it comes to patients who have their annual physical with a male physician but prefer to have a female do the pap/breast exam on a different day- are we able to bill the Q0091 for the pap smear on the second visit or could we do a 99212?
Thanks in advance
Steph

First and foremost there should be some patient education going on here. Normally insurance is going to pay for one preventive exam a year and this can be done by the female which will include what is medically indicated for her age group. In the even these 2 providers are not affiliated you can bill the 993xx code twice and hope for the best. Q0091 is used for a Medicare patient only and normally not recognized by commercial insurance. 99212 might fly if the pelvic and pap was all that was done but you will also have to include the Z code as the reason for the visit which might lead to a denial.