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E/M Same Day as PAP

  1. #1
    Question E/M Same Day as PAP
    Medical Coding Books
    Is is common for a insurance company to deny a Pap smear as "included" in the E/M service done on the same day?
    Example: Patient came in for a PAP and while here mentioned that she had some congestion and sinus drainage. We billed a E/M service for the head congestion etc and also billed for the PAP- but insurance denied. Does anyone have any suggestions on how to (if we can) get both services paid?

    Any help is appreciated.

    Thanks,

    Molly

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    What CPT are you using for the pap? The pap codes in the laboratory section of CPT are not billable by the physician office, only pathology/lab.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    So......it should add to the overall E/M charge?

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    If the "pap" is actually her annual physical, it should be billed as preventive and the problem oriented portion of the visit should be billed as an e/m with mod -25.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default
    We billed a G0101 for the Pap and a 99213 (25) for the office visit and they denied...

    Thanks,

    Michelle

  6. #6
    Location
    Evansville Indiana
    Posts
    451
    Default G0101
    G0101 is actually a Medicare code. Some insurances will accept and some won't, this might be one that doesn't accept this code and includes the service in the E&M for the day.

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