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Pap with routine physical

  1. Default Pap with routine physical
    Medical Coding Books
    What is the right way to bill pap smear(88142) when done during a routine physical exam?
    I usually use icd9 V70.0 and 616.10....most carriers don't pay for the pap when billed this way, I have also billed it with just the v70.0

  2. #2
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    88142 is code for the lab to bill unless you have an on site pathologist. If this is routine physical then why are you using 616.0? does the patient hav e this condition and is it the reason for the pap? is this a complete physical or a well woman exam. if it is a complete physicial with no complaints the use the V70.0 plus a V76.x code for either cervical or vaginal screening depend upon whether the physician performe a cervical or vag pap. If the physician did a well woman then you code only the V72.31 and add the V76.xx code for vag pap if he performed that one. If the carrier does not pay then it is probable due to patient coverage.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    For a well-woman exam we bill the preventative visit E/M & the lab 88142 with the primary Dx of V72.31 for Routine GYN Exam. My office sends the labs out to an external lab, so the 88142 is billed without a charge amount attached. With BC/BC on the 88142 we use V72.31 as the primary Dx and
    V76.2 as secondary so that they know we performed the pap and what it was for (screening for malignant neoplasm of cervix)

    616.0 should only be used as a Dx if that is a condition the patient has, if they do not you essentially are giving it to them by putting it in their medical record so be cautious with your Dx. If the patient in for a routine annual PAP you would still use V72.31 as the primary Dx.

  4. #4
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    I have a contraversy regarding pap,pelvic and Preventative exam. Because our providers are paid by RVU's, they are coding for the 99396 with Q0091 and G0101. some insurances do pay however I feel that this is double dipping. I am sure the elements of a female age appropriate exam include breast pap and pelvic. I just need to prove this. ACOG put out a notice that some of the private insurances are requesting $$ back. I explain the the Q and G code are for Medicare only, but am being told "they need their RVU"S..
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
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    Quote Originally Posted by Coding314 View Post
    For a well-woman exam we bill the preventative visit E/M & the lab 88142 with the primary Dx of V72.31 for Routine GYN Exam. My office sends the labs out to an external lab, so the 88142 is billed without a charge amount attached. With BC/BC on the 88142 we use V72.31 as the primary Dx and
    V76.2 as secondary so that they know we performed the pap and what it was for (screening for malignant neoplasm of cervix)

    616.0 should only be used as a Dx if that is a condition the patient has, if they do not you essentially are giving it to them by putting it in their medical record so be cautious with your Dx. If the patient in for a routine annual PAP you would still use V72.31 as the primary Dx.
    You do not use the V76.2 with the V72.31. If you look in the code book you will notice that the V76.2 is excluded from the V72.31. The only PAP code you add is if you did a vaginal PAP and not a cervical. I would not use the 88142 with the 0 charge as you are not performing that service. It may cause issues for the lab.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by kbarron View Post
    I have a contraversy regarding pap,pelvic and Preventative exam. Because our providers are paid by RVU's, they are coding for the 99396 with Q0091 and G0101. some insurances do pay however I feel that this is double dipping. I am sure the elements of a female age appropriate exam include breast pap and pelvic. I just need to prove this. ACOG put out a notice that some of the private insurances are requesting $$ back. I explain the the Q and G code are for Medicare only, but am being told "they need their RVU"S..
    You are correct you not bill both. The G and the Q are Medicare codes that some payers do accept for the well woman V72.31. How do you prove this? I am not sure but what do you mean by they need their RVUs?

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    We are a CAH method II. RVU's = relative value units. I am not sure exactly but I think it has to do with the procedure codes and how many they perform.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
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    Yes I know that but I am not understanding why your facility is concerned with RVUs versus billing correctly. RVUs are a formula for calculating the amount of reimbursement based on several factors. So If your reimbursement is calculated by the total amount of RVUs billed then to erroneously report these procedures together is artificially elevating the RVUs for the reporting timeframe. The end result is your overall reimbursement will increase but it is not based on factual reporting.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    Seacoast- Dover New Hampshire
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    and this is what I am trying to prove, however, I am told to code what the providers put on the encounter. Tomorrow one of the family practice goes "live " with EMR...This is the one practice that does this.. I am real curious as to how this will work.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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