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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.



  2. #2
    Greeley, Colorado
    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
    Capital Coders, Columbia, SC
    Default should add to the overall E/M charge?

  4. #4
    Greeley, Colorado
    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
    We billed a G0101 for the Pap and a 99213 (25) for the office visit and they denied...



  6. #6
    Evansville Indiana
    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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