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PAP Smear Q0091 clarification

  1. Question PAP Smear Q0091 clarification
    Medical Coding Books
    Hello everyone,
    I was wondering if anyone knows a CPT code for collection of PAP smear equivalent to Q0091?
    Here is the senario: PTN present for routine post-psrtum F/U. 59400 was billed so PPV is included under global. However, during this visit PAP smear was also collected (Q0091). 90% od payers in our area pay for this code. Now I have a payer thats telling me "please resubmite w/ a valid CTP code; Q-codes are not covered".
    Can anyone please help.

    Thank you.

  2. #2
    Q0091 is a code that Medicare began to cover as a benefit to their patients (they allow the charge to be carved out of the preventive service) since they don't cover 99000. You could bill the handling code 99000, but there isn't another code that includes the collection. For commercial payers, that would be included in the lab code for the pap.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. Default
    Thank you Pam

  4. #4
    I'm confused: 99000 doesn't include the collection of the specimen. This is a transport code.

    Why wouldn't you bill an E/M code for the office visit? Since I am assuming the pap is diagnostic, Q0091 wouldn't apply anyway. I am also assuming this procedure is separate from what would normally during the global post-partum period.

  5. #5
    Why was the Pap Smear done? Was there a problem prior to the patient's pregnancy? If it is totally unrelated to the postpartum period, you could probably bill out a level visit with a 24 modifier with a diagnosis related to the reason for the pap smear. But if it was merely a postpartum pap (why would the doc do that anyway if not for a problem) then I think it would be part and parcel of the global period.

  6. Default Professional Pap Fee
    I code the physician professional charge at a rural health clinic in ND, can I charge a 99000 with a preventative code for an annual wellness visit with a pelvic and pap smear done for the physician side? We charge the Q0091 when it's a Medicare pap, but what when it is a commercial insurance?
    Last edited by cintheeyas; 06-27-2012 at 08:25 AM.

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