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Q0091 Not Paid

  1. Default Q0091 Not Paid
    Medical Coding Books
    Can anyone out there help we with this. I am getting denials for Q0091 from BCBS saying that this code is a Medicare and Medicade code only and will not pay. They will also not pay for the 99000 code.
    I am not aware of any other code to use. I would appreicate any help, I have a stack of denials I need to try and rebill.
    I was at a seminar in Feb. and was assured that this Q0091 was the code to use if you were getting denied on 99000. Now I am really



    Thanks so much,

  2. #2
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    Quote Originally Posted by juliejenkins2005 View Post
    Can anyone out there help we with this. I am getting denials for Q0091 from BCBS saying that this code is a Medicare and Medicade code only and will not pay. They will also not pay for the 99000 code.
    I am not aware of any other code to use. I would appreicate any help, I have a stack of denials I need to try and rebill.
    I was at a seminar in Feb. and was assured that this Q0091 was the code to use if you were getting denied on 99000. Now I am really



    Thanks so much,
    88142/90, is what we bill when we send it out to be read. Most commercial payers deny Q0091 with a well check - I know that Aetna and UHC do, as well. Hope that helps!
    Last edited by btadlock1; 04-05-2011 at 07:45 AM.

  3. Default
    What is the /90 sorry I have never seen that?

    Very thankful for your response so quickly

  4. #4
    Default
    Quote Originally Posted by juliejenkins2005 View Post
    What is the /90 sorry I have never seen that?

    Very thankful for your response so quickly
    90 modifier - "Outside/reference laboratory" It just means that someone else actually interpreted the lab, and all you did was take the specimen.

    (Fun fact: Aetna requires it on 88142, if you're not a lab.)

    Hope that helps!

  5. Default
    It helps very, very much. So just so I have this right. My Q0091 should still work for my Medicare and Medicade and rthe 88142 with the 90 modifier should work on all the comm. insurance?

  6. #6
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    You got it!

    But I wouldn't say "all" commercial payers...check on Tricare - they're the odd one out most of the time, and they tend to follow Medicare's rules.

  7. Default
    Thanks sooooooooooooooooo much for helping me fix a big problem I really do appreicate it. Have a wonderful day

    Thanks again

  8. #8
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    The 88142 is a lab code for the lab to use for the preparation of the slides for the pathologist. It is not a code for the doc to use to perform the pap and pelvic exam. To obtain the pap is part of the visit level.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    Quote Originally Posted by mitchellde View Post
    The 88142 is a lab code for the lab to use for the preparation of the slides for the pathologist. It is not a code for the doc to use to perform the pap and pelvic exam. To obtain the pap is part of the visit level.
    I would like some more imput on this. I am collecting the pap in the office and then sending it to a outside lab. I don't feel that it should be part of the visit.

    Thanks for any thoughts

  10. #10
    Default
    Are you using a ThinPrep pap kit? I hadn't considered that not everyone uses those...
    You can find the coverage criteria for BCBS here (from all over, but it's usually similar from state to state on this kind of stuff):

    This one has the best shot of giving you the answer you need:
    https://www.bluecrossca.com/provider...pw_b130805.pdf

    Here are some others:
    http://www.bcbstx.com/health/pdf/537...guidelines.pdf

    http://medicalpolicy.hcsc.net/medica...08-04-01#hlink

    http://www.bcbsnm.com/pdf/pcgs_provider.pdf

    Here's one on 99000 for you too...
    http://www.bcbsnm.com/pdf/provider_r.../section13.pdf
    "Laboratory services are reimbursed at a fee-for-service rate according to the BCBSNM maximum allowable fee schedule. The handling or drawing of the specimen is considered part of the laboratory procedure; therefore, an additional charge for drawing or handling will not be reimbursed. However, BCBSNM will reimburse the provider for drawing or handling when the specimen is sent to a laboratory other than the provider's office lab and the laboratory procedure is billed separately by the independent laboratory. Bill with procedure code 36415 (for routine venipuncture) or procedure code 99000 (for handling) when appropriate, but not both. Handling codes are pended for review by Health Services."

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