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Need help asap! coding pap/pelvic

  1. #1
    Angry Need help asap! coding pap/pelvic
    Exam Training Packages
    Normally we code our female physicals including a pap and pelvic breast exam with a preventative med est pt level based on the persons age which use code V700. We also code the pelvic/breast exam with G0101 with V7231 and the pap Q0091 with code V762. Insurances other than Medicare usually cover these codes. However we just got an EOB from Assurant Health stating the G0101 and Q0091 are only for use with Medicare insurance. I have treid calling Assurant Health to tell me what codes they prefer but they will not tell me anything. So, does anyone know what codes should be used? I have tried looking in the CPT and HCPCS book but can not find anything. I can resubmit a corrected claim to get reimbursed more than the $3.21 they are willing to pay if I can get these codes. Thanks and I would appreciate any feedback that I can get.

  2. #2
    Location
    Fort Smith, AR
    Posts
    45
    Default pap/pelvic
    As I understand it, G0101 was set up for Medicare services for pelvic and the Q0091 for screening Pap smear mainly because they do not pay for the "wellness" preventative medicine codes. We bill out the Q0091 for some commercial insurance companies but not all will pay it because they bundle it in with the age appropriate "wellness" preventative care service. We never bill the G0101 on non-medicare patients because payers other than Medicare don't recongnize or consider it bundled.
    Rachel Nelson, RHIA, CPC-A

  3. #3
    Default
    To be honest, I have never filed the G0101 and Q0091 with any insurance other than Medicare. When billing to Medicare, I do carve out the allowable of the G & Q code from the Preventive Medicine Service, so we are still billing the full price of the Preventive Medicine Service, but Medicare pays for a portion of it with the G & Q. For commerical payers, I only bill the Preventive Medicine Service at full price, since the pap/pelvic are actually included in that service. The G & Q are only for Medicare, and if other insurances are paying for it, then I don't think the full price of the Preventive should be billed also. Just my take on it. So, to answer your question, I don't believe you should be billing Assurant Health for the pap/pelvic, only the Preventive Medicine Service (99381-99397).



    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  4. Default
    i need help please,what is the procedure code for floride tx V07.31 i have d1203 but amerigroup is stating that i need to bill a dental ins for payment. we never had to do that before now thats their reason for not paying.

  5. #5
    Location
    Gainesville, GA
    Posts
    44
    Default pap/pelvic
    You want to bill for the preventive medinice by age. New patient 9938x or 9939x for Established patients.

    V72.31 is the diagnosis for Routine GYN Exam.

  6. Default
    i have a challenge for all you coders im included i am not abel to find a procedure code for V07.31 that will satisfy amerigroup can you help

  7. #7
    Location
    Charleston, South Carolina
    Posts
    641
    Default
    rgodinez,

    You do not code a procedure to justify/satisfy the diagnosis for payment, you code the procedure that was actually performed. If it happens to not be a covered benefit, that's unfortunate, but coding otherwise may be construed as fraud. Also, billing a dental code on a medical claim is incorrect, you need to bill the dental insurance.
    Last edited by mmorningstarcpc; 03-22-2011 at 08:45 AM.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

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