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Gyn exam/Physical Exam

  1. #1
    Seacoast- Dover New Hampshire
    Default Gyn exam/Physical Exam
    Medical Coding Books
    We have some discussion regarding pts getting V72.31 with the preventative codes and Q0091. A couple of the insurance companies do not want to pay 99396 as they already pd once this year. Is there somewhere in ACOG that states folks can have their PAP in the GYN office and reg Physical at the internal medicine office. Should I be appending 52 if she has already had the reg Physical? Some of our offices do not want to do paps.Thanks for your help in advance.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Seacoast- Dover New Hampshire
    Default gyn
    Any takers on this question?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Greeley, Colorado
    We have similar issues. Some carriers simply do not allow for these services to be done this way. I woudn't use -52 on any E/M or preventive visit, and since the 2nd one is not getting paid at all, why would you? Also, we do not use Q0091 for anything but Medicare. I'd like to know if you get paid for Q0091.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Default Suzanne H, CPC SLC UT
    I am interested on anyones feedback on this issue. I have been trying to figure out the best way to bill for a pap test also.
    The only code that seems appropriate is the Q0091 as long as it is for routine collection. But because this is a medicare code, is it appropriate to use it for everyone that we collect a routine pap smear on- all insurances?
    ACOG from 2004 is the only reference that I have found that states, a pap smear collection is billable only when it is a routine pap-separate from the E/M. If the pap smear is collected because of a previous abnormal pap smear, it should be included in the E/M as part of the service.
    So which code is it? Anyone???????

  5. #5
    I have been getting Q0091 paid in my office except for this one insurance company that states that wasn't an effective code until April of 2008. The customer service girl told me that I need to rebill with another pap screening code to get it paid. But all I find in the codes that a lab uses, so I am confused. So does anyone have any idea what the other pap screening code they are referring to.

  6. #6
    I've personally never heard of well-woman exams being denied because the patient also had a check up at the PCP. For a well woman exam with a pap, are you using V72.31? You should be.

    According to CPT and ACOG, collection of a screening pap smear is included in 99384-99397, the same way that collection of a diagnostic pap smear is included in the E/M code. Q0091 is to report the service to Medicare because preventive benefits are a general exclusion under the medicare program. I would say that you should check with your payers to see what their reporting requirements are for a screening pap smear, and whether they recognize the use of this code for non-medicare patients.

    And you are right - you would not use the codes from the lab section unless you are actually performing and reading the test.
    Patricia A Hubbard, CPC, COBGC
    New York

  7. Default
    The definition of V72.31 is Routine GYN Exam. If she had a physical with her PCP and they coded V72.31 but did not do a GYN exam, they coded it incorrectly and need to correct their claim in order for you to get paid for the GYN annual exam.

    We also use the Q0091 for the collection and conveyance of the pap for all but a few payors. We use 99000 for this with Healthnet. I would say about 1/3 of our payors pay for the Q0091 code. This is only to be used if you collect the specimen and send it to an outside lab.

  8. #8
    salem nh chapter
    From my experience Q0091 is used for a routine pap smear for Medicare and Medicaid patients.

    Also, for a routine gyn exam the diagnosis v72.31 is specific enough. There are some insurances out there that will only allow one annual physical exam a year.
    Hope this helps!

  9. #9
    Kansas City, MO
    This is an issue that is payer and policy specific. There is no way that we as providers can know all of the nuances of a patients policy. All we can do is accurately report and code our services. We have taken this stance with our patients "Traditionally insurance will cover one physical a year. If you have seen your primary care for this service, it is possible that they may not cover all or part of your service today. It is your responsibility to know your benefits and policy coverage."

    It is possible that the primary physician is coding it wrong. More often then not we are finding out that the patients only have benefits for one physical a year or they only have a benefit for the pap & pelvic and mammogram only.

    As for the Q0091 we have several carriers, besides Medicare that reimburse this service.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

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