# Billing e/m w/ Q0091 to Medicare



## Alison Conley (Sep 2, 2010)

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


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## mitchellde (Sep 2, 2010)

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.


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## cheermom68 (Sep 3, 2010)

*99215*

I agree.  What was the diagnosis for the 99215??
LeeAnn


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## ttspoon (Oct 13, 2016)

*From CMS...*



Alison Conley said:


> 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


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