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How to code for PAPs

  1. Default How to code for PAPs
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    My main issue is coding for PAPs with Well Visits, PAPS with E&M and PAP only billing. Basically I understand for commercial Insurances Well Visit coding 99385 etc; include the PAP fee in them and for E&M we put a modifier to 99213 etc -25 and G0101 (Well Woman Code) + Q0191 (Pap Smear) and we used to get paid for the G0101 but off late we are not and for Simple paps we just bill G0101 + Q0191 and we get about 25 - 40 bucks which seems like a pittance.

    Can we code V72.31 with 99214 for a PAP? Any advise is appreciated

  2. #2
    Location
    Tampa, Florida
    Posts
    63
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    in my office we have been using 99214 with V72.31 and we are getting paid. we also use the G0101 and only a few insurance carriers are paying this code.

    hope this helps
    Nickie, CPC

  3. #3
    Default
    Quote Originally Posted by asekaran View Post
    My main issue is coding for PAPs with Well Visits, PAPS with E&M and PAP only billing. Basically I understand for commercial Insurances Well Visit coding 99385 etc; include the PAP fee in them and for E&M we put a modifier to 99213 etc -25 and G0101 (Well Woman Code) + Q0191 (Pap Smear) and we used to get paid for the G0101 but off late we are not and for Simple paps we just bill G0101 + Q0191 and we get about 25 - 40 bucks which seems like a pittance.

    Can we code V72.31 with 99214 for a PAP? Any advise is appreciated
    We used V72.32 for pap and no we don't rec'd no add'l monies....lol
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
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    You should not use a 99214 for an annual well encounter it should be the preventive code. There is no CPT code for the PAP because this is considered to be part of the exam. If you are performing a sick visit with a PAP then the PAP is still considered to be an integral part of the exam.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
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    I agree with Debra here! I also thought that the G code and the Q code were only for Medicare.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. #6
    Location
    Tampa, Florida
    Posts
    63
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    Hey Debra,

    so can we charge charge 99385 for a pap and then on another day charge a 99385 for a physicial? In our office we do not do both an pap and physical on the same date because the physician spend alot time on both.

    thanks

    Nickie, CPC

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
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    We have checked with most of our commercial payors and they do recognize the G an Q codes when NOT performed during the same encounter as the preventive code. If your patient is coming back just for the breast/pelvic/pap, you can code Q0091 and G0101 w/V76.2. I would not recommend a second preventive code at this encounter and definately not an E/M.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Location
    Tampa, Florida
    Posts
    63
    Default
    o.k, I'll try it this way
    Thanks Lisa

    Nickie, CPC

  9. #9
    Location
    Columbia, MO
    Posts
    12,570
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    Nickie, I agree with Lisa, sorry for the delay in my response the internet was down all day!

    Debra A. Mitchell, MSPH, CPC-H

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