Results 1 to 7 of 7

Can we code/bill for Q0091 with preventative code

  1. #1
    Red face Can we code/bill for Q0091 with preventative code
    Medical Coding Books
    So I have read alot of threads about using the Q0091 with the G0101 and then it sounds iffy to use the Q0091 with Preventative E/M codes. I work at the VA and haven't got alot of females until recently and would like more guidance from coders that work in the OB/GYN arena and have seen these bills get reimbursed and know the guidelines on this. Any help would be greatly appreciated. It really should be cut and dry but it never seems to be. Also any links to references would be so appreciated also.

    Preventative E/M with Q0091 (no signs or symptoms)- yes or no

    Thanks so much

  2. #2
    Default
    Is this for a Medicare, Medicaid, or commercial patient? SC Medicare will allow you to bill the preventive code with a modifier with Q0091 and G0101, but they will not pay the preventive code, the patient is responsible. Then you have to reduce the amount owed by the patient by the amount paid for the pap and breast/pelvice exam. It gets very tricky! We tried it, made a lot of patients upset over the billing, and finally stopped billing the preventive code and only bill the pap, breast/pelvic, ua, and stool if done.


    Lisa

  3. Default Medical Reimbursement
    Is it appropriate to bill Q0091 with preventive medicine code using the guidleines provided by CPT-HCPCS regardless of insurance type?

  4. #4
    Default
    Thanks...this would be a non medicare pt please.

  5. #5
    Location
    Glendale AZ
    Posts
    18
    Default
    no Q0091 is inclusive in the e&m for commercial payors. Many will initially pay and then come back to recoup.

    Traci, CPC

  6. #6
    Default Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection
    Quote Originally Posted by missbren71 View Post
    So I have read alot of threads about using the Q0091 with the G0101 and then it sounds iffy to use the Q0091 with Preventative E/M codes. I work at the VA and haven't got alot of females until recently and would like more guidance from coders that work in the OB/GYN arena and have seen these bills get reimbursed and know the guidelines on this. Any help would be greatly appreciated. It really should be cut and dry but it never seems to be. Also any links to references would be so appreciated also.

    Preventative E/M with Q0091 (no signs or symptoms)- yes or no

    Thanks so much
    This came from a BC/BS policy...
    Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

    We would like to take this opportunity to remind providers that obtaining a Pap smear is integral to the office visit, including both preventive and routine office visits. Separate reimbursement is not allowed for HCPCS code Q0091.

    According to the American Congress of Obstetricians and Gynecologists, code Q0091 should not be reported to non-Medicare payers for Pap smear collection, as the collection of a Pap smear is included in the E&M or preventive service.

    The Q0091 code was developed by Medicare for the exclusive purpose of reporting services provided to Medicare patients. Providers should report this code to Medicare only for the collection of screening Pap smears for Medicare patients.

  7. #7
    Default
    I would also check the ACOG website; they have information specific to this issue.
    Leandra Tufts, CPC, CEMC, COBGC

Similar Threads

  1. Preventative Visit E&M and Q0091??
    By Marje in forum Family Practice
    Replies: 2
    Last Post: 04-11-2014, 09:31 AM
  2. Preventative code or G0101
    By aschaeve in forum OB/GYN
    Replies: 2
    Last Post: 09-25-2012, 03:39 PM
  3. Preventative and seperate E/M code
    By tmerickson in forum E/M
    Replies: 5
    Last Post: 08-19-2010, 11:34 AM
  4. Q0091 pap code HELP!
    By knudsen.lisa in forum OB/GYN
    Replies: 1
    Last Post: 03-22-2009, 08:11 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.