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papsmear billing

  1. Exclamation papsmear billing
    Medical Coding Books
    I'm getting denials from Medicare for code G0123 DX is 795.05 and denied for inconsistent with dx, I tried pulling in the LCD and there is nothing.

    also i'm getting denials from other Commercial insurance for code 87621, 87491, 87591 with dx V76.2 is not included in well benefit.

    any kind of information will be appreciated!!

  2. #2
    Default pap smear billing
    The G0123 is the screening code, so I use the V76.2.....If vaginal smear V76.47

    As for your commercials, the 87621 is an HPV screening.
    If positive for HPV I use 795.05
    If negative and the patient has a pap with ASCUS or higher, use the pap dx......if it's a normal pap I've been using V73.81.
    You are not alone in getting paid for the hpv....it's been a battle.

    Good luck!

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by rlmarkow View Post
    The G0123 is the screening code, so I use the V76.2.....If vaginal smear V76.47

    As for your commercials, the 87621 is an HPV screening.
    If positive for HPV I use 795.05
    If negative and the patient has a pap with ASCUS or higher, use the pap dx......if it's a normal pap I've been using V73.81.
    You are not alone in getting paid for the hpv....it's been a battle.

    Good luck!
    If it is screening you must use the screening code first listed regardless of whether the payer pays or it is patient responsibility. Screening is an asymptomatic patient that is having testing due to predetermined criteria, you cannot change the patient after the test is done and make them symptomatic, The only correct way is to code screening first and findings secondary. Please check your coding guidelines.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    Debra is correct. The procedure specifies that a screening is being performed. You would not perform a screening if signs and symptom are present. If you are performing a screening pap, the only possible indication is a screening code.

    Any findings are reported as the secondary dx code in the 795.XX range.

    WK

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