Ob-Gyn Coding Alert

Question: Should Q0091 be bundled with preventive services? We started billing Q0091 in November and received payment from almost every insurance company. Now the insurers are starting to deny it as mutually exclusive. Codes 99381-99397 state gender- and age- appropriate history and exam, etc., but then they say ordering of tests, not performing them.

Georgia Subscriber Answer: Watch out -- some payers are starting to substitute Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for preventive medicine services (99381-99397) and are then paying less.
 
The American College of Obstetricians and Gynecologists is very clear that you should include the collection of the Pap in the preventive service -- except in the case of Medicare where they do not cover the full preventive service and let you carve out the part they will pay for.
 
When doing the annual and collecting the Pap, you should only be billing the (usually) well-paid preventive service with 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) for Pap handling, but not Q0091 for the collection.