Wiki Q0091 clarification

[desireewhite185@yahoo.com]

Hello,
I do the coding for RCH OB/GYN clinic. I was hoping to get some clarification on the pap code Q0091.
I have not been using it as when I was trained I was told it was a lab fee and the insurance companies don't pay for it.
My manager is trying to run a report of how many pap smears we do and asked what would be the code.
I think the only code would be Q0091, but I haven't been entering it. Should I be for all paps/some paps/only some insurances?
Thanks, Des

 

[nielynco]

Hello,
I do the coding for RCH OB/GYN clinic. I was hoping to get some clarification on the pap code Q0091.
I have not been using it as when I was trained I was told it was a lab fee and the insurance companies don't pay for it.
My manager is trying to run a report of how many pap smears we do and asked what would be the code.
I think the only code would be Q0091, but I haven't been entering it. Should I be for all paps/some paps/only some insurances?
Thanks, Des

Yes you should. Q0091 is not a lab code, but the code for professional services incurred in obtaining, preparing and sending the pap specimen to the lab. But the hitch is that is usually only covered by Medicare (and sometimes Medicare also wants it billed). Private insurance does not usually cover this code so if you bill them you will be dealing with a denial each time. You could just enter the code with a 0 charge in those cases so you can keep easily tracked information. In some cases, commercial insurance might reimburse 99000 for handling of the pap specimen, but very infrequently. There is no other code that will tell if you did a pap on the patient unless you have a way to capture the lab code for a Pap for ordered tests.