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Family Practice

  1. #1
    Question pap screen/handling
    Clearnace Sale
    Hi, I've just recently started billing for a family practice clinic in NH and I'm not familiar with how some procedures need to be billed. For codes 99000 billed with Q0091, it looks like most insurance don't pay for this. They are denied stating they are incuded in another service. They've been billed in the past with diag V76.2. I would appreciate any information/help with this.

    Last edited by sstone; 02-13-2008 at 11:54 AM. Reason: clarifying subject

  2. #2
    Jacksonville, Florida - 90417
    Default Family Practice

    According to the definition of Q0091 in Level 2 HCPCs, it states, "obtaining, preparing and conveyance of cervical or vaginal smear to laboratory." As such, one cannot bill 99000 in addition to Q0091 because 99000 is in essence a code for conveyance of a specimen from an office to a lab and that is already included in the definition of Q0091.

    Hope this helps.

    Maryann Palmeter, CPC

  3. #3
    Thanks Maryann,

    Yes, it does help. It makes me feel like I know what I'm doing, but why would a payor reject saying it's included when CCI edits say it can be billed with other codes?

    Sharon Stone, CPC

  4. #4
    north seattle wa
    Default paps
    Some private payors won't pay for the Q0091. They consider it included in the exam, so does ACOG. Medicare does pay for the Q0091 in addition to the exam code.


  5. #5
    Medicare will pay for the Q0091 once every 24 months. Some private payers will also pay this but the majority of them will bundle this services. You need to check with each of you payers to see if they will pay for this in addition to your physical codes.

  6. #6
    Default Q0091 And 90000
    What if the Dr is doing a pap and handling Q0091 and other labs with handing of 99000. Are both handling fees able to be billed in this situation?
    Any help is appreciated.

  7. #7
    Default Just some extra input.
    I work for a multi-specialty practice. The bulk of the services I go through is Family Practice.

    I suggest you always use Q0091 for collection of the pap smear vs. 99000. The reimbusement is more frequent then 99000 handling charge. Plus the reimbursment is higher. I've seen a range payment for Q0091 between 30.00-45.00 dollars. Which isn't bad.

    Regarding if you can bill Q0091 and 99000 at the same time. As long as there not for the same services. Like you mentioned. Just be sure to link the Dx's correctly. No guarentee on payment. But you can bill both. Just a side note, I've seen 99000 get kick back a lot.

    Daniel, cpc

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