yearly physical plus pap

kimb

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patient came in to see family phy. for yearly physical and also had a pap would it be coded as:

99396
v70.0 for physical

and

99000
v76.2 or v72.31 for routine pap
 
Last edited:

Christine Bekker

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I was under the impression that Medicare has allowed the V72.31 to be the primary Dx on the Wellness CPT code, and so far our office has had no problems using this code as the primary dx with other payers.

Christine
 

kimb

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annual physical/pap

how would you code a physical with a pap. patient was seen by family physician not by gyn. patient came in to have her yearly physical and also wanted the Physician to do her pap.

99396 - v70.0

99000 - v72.31 or v76.2
 
Last edited:

dmaec

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if it's a medicare (not a welcome to medicare px) and routine pap/px I'd code:
99396.GY- V70.0
G0123 - V76.2
Q0091 - V76.2

Welcome to MC px IF all criteria is met and routine pap:
G0344 -V70.0
G0367 -V70.0
G0638 -V70.0
G0123 -V76.2
Q0091 -V76.2

Commercial Insurances:
99396 - V70.0
88142 - V76.2

I've never used the 99000 UNLESS the specimen was actually transfered from say the clinic to an OUTSIDE facility lab.

Donna :)
 

daniel

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Hey if your just coding a physical with a PaP smear.

Just bill


99385-99387 series
or
99395-99397 series

depending if there new or est.

And if your practice is just collecting and sending the pap smear out use
Q0091 with V76.2.

Example

99385- V72.31
Q0091- V76.2

Regarding the G0123 or 88142.
The G0123 looks like this only applies if your collecting the pap smear and reading the sample inhouse.
And 88142 is what the pathologist use when you send out the pap smear to them. So becareful in some of the advice you receive regarding your question.

Also the first scenario you posted is correct. But most PPO will not reimburse for the 99000 for the collection of a pap smear. Little trick to the trade. Thats why many coders picked up the Q0091.

Respectfully
Daniel
CPC
 

rthames052006

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York, Pa
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Hey if your just coding a physical with a PaP smear.

Just bill


99385-99387 series
or
99395-99397 series

depending if there new or est.

And if your practice is just collecting and sending the pap smear out use
Q0091 with V76.2.

Example

99385- V72.31
Q0091- V76.2

Regarding the G0123 or 88142.
The G0123 looks like this only applies if your collecting the pap smear and reading the sample inhouse.
And 88142 is what the pathologist use when you send out the pap smear to them. So becareful in some of the advice you receive regarding your question.

Also the first scenario you posted is correct. But most PPO will not reimburse for the 99000 for the collection of a pap smear. Little trick to the trade. Thats why many coders picked up the Q0091.

Respectfully
Daniel
CPC
Daniel,

I agree with what your saying about the Q-code alot of payers are reimbursing for that and not only medicare. The office I work at now uses the S0612 for Blue shield Pap's ( not the specimen collection code).

So for example if pt comes in for Physical and Pap ( I don't have my books at home but the 99385 87 code of 99395-97; and s0612 ( if it's blue shield or Cross).

But I know where I used to work we used the q0091 for Blue cross and they paid it but was it coded correctly.... I can't say. It's something worth looking into.

This topic is always a buzz. I"m hoping our coding committee can come up with some concrete recommendations on this topic in the near future.
 
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