Wiki 87210 or Q0111 FQHC

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AngelicaCorc

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I am so confused on what to use for a wet prep. Our facility bills Q0111 and 87210 when the physicians orders a wet prep. For FQHC, are we supposed to be billing both or one? I have had another co-worker tell me that one of the other billers told her to use modifier 25 on the 87210. I just had a claim deny CPT code 87210 for medical necessity but I want to make sure I should be billing it with the Q0111.
 
Hi AngelicaCorc,
I am reviewing your inquiry and have questions.
Your facility is billing 87210 with Q0111 for a wet mount on EXACTLY what type of specimen here?
When you state facility (may I assume you are referring to that someone else enters those charges and you are simply reviewing them)?

Okay let us review what we know at this point -
87210 Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)
Q0111 Wet mounts, including preparations of vaginal, cervical , or skin specimens
I quick checked and there are no modifiers needed for these two procedures to be billed for same DOS (day of service).

Next let us look at your question "CPT code 87210 for medical necessity" but you are questioning if 87210 can be billed with Q0111. That is the piece we do not know.
Q0111 is very broad and seems to include just about everything, whereas 87210 includes somethings (except skin, hair or nails). Is this what you are questioning?
I did run both Q0111 and 87210 through LCD look up for AR (Arkansas) and there isn't anything. Is it another payor plan you are dealing with? Many plans have their own policies that need to be reviewed.

I also agree Modifier 25 would not be appropriate for this coding scenario.

Do you have any insight to offer? I hope I have provided some insight.
Have a fantastic evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
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