Results 1 to 4 of 4

Billing e/m w/ Q0091 to Medicare

  1. Unhappy Billing e/m w/ Q0091 to Medicare
    Exam Training Packages
    I am looking for any insights on this combo. 99215.25 with matching dx and exam portion to support (not pelvic related), but Q0091 was billed additionally. Medicare is bundling the 99215.25 as inclusive with the Q0091 dx V76.2... I have searched the Medicare website and I do not see any specific bulletins stating that a different modifier should have been used on either code.
    If anyone has had this come up or knows the answer I would be grateful. Thanks

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    was this a well woman exam? If so then why are you using the 99215? I am not seeing the correlation between a visit for a problem of a 99215 caliber then doing a pap for screening.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Evansville Indiana
    Posts
    451
    Default 99215
    I agree. What was the diagnosis for the 99215??
    LeeAnn

  4. Default From CMS...
    Quote Originally Posted by Alison Conley View Post
    I am looking for any insights on this combo. 99215.25 with matching dx and exam portion to support (not pelvic related), but Q0091 was billed additionally. Medicare is bundling the 99215.25 as inclusive with the Q0091 dx V76.2... I have searched the Medicare website and I do not see any specific bulletins stating that a different modifier should have been used on either code.
    If anyone has had this come up or knows the answer I would be grateful. Thanks
    I think it's probably due to frequency as it is only allowed every 2 years if not high risk. This is what I found...

    From CMS MLN ICN 006559 OCT 2016

    Q0091 – Screening Pap smear; obtaining, preparing and conveyance to lab

    ICD-10 Codes
    High risk – Z77.21, Z77.22, Z77.9, Z91.89, Z92.89, Z72.51, Z72.52, and Z72.53
    Low risk – Z01.411, Z01.419, Z12.4, Z12.72, Z12.79, and Z12.89

    Who Is Covered
    All female Medicare beneficiaries

    Frequency
    ● Annually if at high risk for developing cervical or vaginal cancer or childbearing
    age with abnormal Pap test within past 3 years
    ● Every 2 years for women at normal risk

Similar Threads

  1. Medicare G0438/G0439 & G0101, Q0091 Billing
    By n2horses in forum Medicare Regulations
    Replies: 2
    Last Post: 03-28-2016, 02:51 PM
  2. Billing Preventative & G0101 & Q0091 together
    By az2tn@yahoo.com in forum OB/GYN
    Replies: 4
    Last Post: 06-27-2013, 06:45 PM
  3. Billing Q0091
    By broo4909 in forum Family Practice
    Replies: 2
    Last Post: 11-13-2008, 09:24 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.