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Problem oriented visit and PAP

  1. Default Problem oriented visit and PAP
    Medical Coding Books
    Can someone chime in on this? If we bill 99213 based on the LOS, and a pap was done during the visit, we can bill the Q0091, correct.

    We are getting denials indicating this Q0091 is included in service with 99213, however there is no bundling issues per CCI.

    This pertains mostly to PPO and commercial payers.


  2. #2
    Default q0091
    Hi - I only use the Q0091 when billing medicare carve outs for Paps.
    Otherwise a provider performing a pap is including in your E & M and the lab charges are billed seperately based on cpt codes - hope this makes sense
    S. Stevens, CPC

  3. #3
    Default E/M w/pap charge
    I would bill a pap with a prob visit and attach a -25 on the E/M. Regence, Aetna, and UHC are beginning to deny paps if billed with a prob visit. WA state medicaid won't pay for paps at all.

  4. Default Q0091 reimbursement
    Ok, I have sent out appeals to our major carriers and will watch to see what they do. Strictly from a coding aspect, Q0091 is billed anytime a pap is collected. For Medicare, we bill G0101 and Q0091, Medicare does pay for both.

  5. Default
    Quote Originally Posted by bradydj View Post
    Can someone chime in on this? If we bill 99213 based on the LOS, and a pap was done during the visit, we can bill the Q0091, correct.

    We are getting denials indicating this Q0091 is included in service with 99213, however there is no bundling issues per CCI.

    This pertains mostly to PPO and commercial payers.

    The "Q" code is used only with medicare. In the past we used 88142 for the pap. The
    88142 is used mainly in an hospital setting since it requires interpretation by a pathologist. With most commercial carriers 88142 is bundled into the office visit code.
    Last edited by GAILWILLIAMS; 07-07-2010 at 07:34 AM.

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