Results 1 to 8 of 8

V15.89 (high Risk Pap)

  1. #1
    Default V15.89 (high Risk Pap)
    Exam Training Packages
    We are billing for a Medicare patient who came in for a screening pap who is high risk. We do not have the info as to why the patient is high risk. When the charge was entered the coder entered it with only the V15.89 ICD-9 code. It hit an edit stating that this V15.89 code is not a primary DX for Medicare. I have always billed the V76.2 (pap screening) as the primary with the V15.89 as secondary and have never had a problem unless the MD has indicated to me the reason they are considered high risk but most of the time those codes aren't acceptable as primary either. The new coder does not feel the V76.2 and V15.89 is correct. Any advice?
    Christina Lee Wagner, CPC, CPC-H

  2. Default
    I agree with your new coder. You should bill V15.89 only, as long as the physician states the patient is high risk. You would not bill V76.2 and V15.89 because the patient is either one or the other. I am not sure why your edits are denying this. I bill this code with Medicare dialy.

  3. #3
    Default high risk pap
    Can you use V72.31 routine gyn exam for the pap? the V15.89 can't be used as first listed according to ICD-9, it's only an additional diagnosis. If the patient is high risk, it wouldn't be a screen. Will have to check a little further on this one. interesting!

  4. #4
    Location
    Kansas City, MO
    Posts
    751
    Default
    In this instance, Medicare direction for billing the G0101 and the Q0091 trump the ICD-9 coding rules. Medicare says if the patient qualifies as High Risk to use the V15.89. Most practice management systems edits are very generic, and don't recognize insurance specific rules. Some systems will allow you to create you own carrier specific edits to help in this instance.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  5. #5
    Default pap
    Quote Originally Posted by amjordan View Post
    In this instance, Medicare direction for billing the G0101 and the Q0091 trump the ICD-9 coding rules. Medicare says if the patient qualifies as High Risk to use the V15.89. Most practice management systems edits are very generic, and don't recognize insurance specific rules. Some systems will allow you to create you own carrier specific edits to help in this instance.
    Thanks, I'm not a biller, so I'm learning as I go. This is interesting to me. They have moved me into the office with the billers (I code the procedures and help with offices) and am learning a lot! It sounds like each carrier has their own specifications as to what is acceptable to them. Confusing!

  6. #6
    Location
    Kansas City, MO
    Posts
    751
    Default
    Quote Originally Posted by Anna Weaver View Post
    Thanks, I'm not a biller, so I'm learning as I go. This is interesting to me. They have moved me into the office with the billers (I code the procedures and help with offices) and am learning a lot! It sounds like each carrier has their own specifications as to what is acceptable to them. Confusing!
    Anna - Yes, it gets very confusing, especially in OB/Gyn. You will find that it is very important to know what your carrier's coding and billing policies are. What is correct by CPT and ICD-9 may not necessarily be the interpretation of the carrier.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  7. #7
    Default
    Anna- I would be careful with the diagnosis V15.89 for Medicare. Medicare has very specific guidelines for V15.89-High Risk. Most patient's don't qualify for a high risk diagnosis and the physician just stating the patient is high risk is not good enough. I would review you carriers LCD for high risk qualifiers and make sure the patient's documentation supports this diagnosis.

  8. Default High Risk E&M
    I have a pt that has breast cancer currently. Pt had a pap done. Dr is using the 174.9 breast cancer code for the E&M, can I still put the V15.89 on the E&M or just the Q0091 and G0101?

Similar Threads

  1. High Risk Pap Smear
    By lizzand3 in forum OB/GYN
    Replies: 2
    Last Post: 06-10-2013, 11:02 AM
  2. High risk pap - signature on the ABN
    By Leandra in forum Medicare Regulations
    Replies: 1
    Last Post: 01-20-2012, 04:31 PM
  3. High risk pap
    By tlw1977 in forum Diagnosis Coding
    Replies: 1
    Last Post: 06-29-2011, 06:01 PM
  4. Re: high risk pap for Medicare
    By cynthiaj54 in forum OB/GYN
    Replies: 1
    Last Post: 10-11-2010, 02:50 PM
  5. Medicare pap high risk definintion
    By tkeeton7885 in forum OB/GYN
    Replies: 1
    Last Post: 10-11-2008, 10:31 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.