Wiki Repeat pap screening

candiced

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Hi everyone, I need a bit of guidance. A patient came in for a repeat pap screening due to inadequate sample. We billed using dx:
1.R87.615
2.Z12.4
Blue Cross did pay, however, applied a $20 copay. Patient is stating Blue Cross advised her we need to remove the R87.615 dx in order for it to be processed as preventative with no copay. 6 months prior we billed the Z12.4 for the initial screening.

I don't feel I would remove the R87.615.

Thank you.
 
R87.615 is appropriate in this setting in my opinion. I would consider changing the ORDER of the codes, but would not be OK removing R87.615.
What CPT exactly are you billing for? The visit? The pathology?
 
Each insurance creates their own policies, but from my experience, since it is an outpatient visit, not a well woman (preventative medicine 99381-99397), regardless of the diagnosis, there will be a copay applied.
In gynonc, I have billed Z12.4 or Z77.9 (high risk) hundreds of times, but don't recall ever seeing a copay not applied since we are not performing/billing for a preventative visit.
If the insurance is stating Z12.4 as primary would change the processing of 99213, I would rebill it that way (even though I don't believe it would).
 
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