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Pap at Physical

  1. Default Pap at Physical
    Exam Training Packages
    We are told that Pas at Physical paid separately with modifier 25.
    If anyboy familiar this, could you help us. for the Pap... what code to be used?
    Modifier to append to Preventive code???
    Any comments very helpful.
    Thank you

  2. #2
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    There is no code for a pap other than the G code for Medicare. The pap is part of the exam.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    I agree with Debra.

    But to add something else here....if the patient presented for the pap only, you could report HCPCS code Q0091, Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. If a separate E/M was performed in addtion to the obtaining of the pap smear, you could report Q0091 and an E/M with modifier 25.

    Just my two cents for whatever it is worth!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
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    Yes that is it the Q code I always get that confused with the G code! My apologies. But you cannot use it with an E&M unless the E&M was for some completely different issue and the pap was for screening. If the Patient presented with a problem and a pelvic exam was necessary to dx the problem and a pap was obtained to help in the diagnostic effort then it is just part of the E&M.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    I agree that the E/M must be unrelated to the pap in order to use Q0091 and an E/M together. In this case, you would report the E/M with modifier 25.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. Default
    Thank you for your help.
    So Q0091 (pap handling) is paid by commerical carrier too?
    if pt is Preventive...99385 & pap Q0091
    modifier 25 to 99385?
    Am still

  7. #7
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    If the patient presents for her annual physicial and a pap smear is obtained during the course of the annual physicial, then there is no addtional code for the pap. It is inclusive of the preventive. Code Q0091 is used if the patient presents for a pap smear only. If a separate, unrelated E/M was performed in addtion to the obtaining of the pap smear, you could report Q0091 and an E/M with modifier 25.

    You may want to reference your payers here on reimbursement as guidelines I'm sure vary.

    Hope this helps.
    Last edited by dballard2004; 06-18-2010 at 01:33 PM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  8. Default
    Thank you for your time.
    to summerize: Pap at Preventive ....9938/9939 seriese....included
    Pap w/EM....but Pap for pure screening (V762)...Q0091 and E/M
    Pap w/EM...medically necessary(611,,,serise ICD-9) included E/M
    we are receving so many SCREAMINGs from Dr.'s offices...pap demand separate room w/two persons needed to be present & the kit(expensive slowaway)...
    normally need 10-15minutes to done...WHY NO PAY???
    Don't you agree.
    Anyway, thank you. now clear.

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