Wiki Annual Prevent with Pap

[nickole805]

Question for anyone out there! I work for a general practice and we have just started seeing issues with the Z00.00 and Z01.419 billed together when a physical is done with a pap and pelvic. We thought logically we should then remove the Z00.00 considering the patient had a pap/pelvic and only bill Z01.419 BUT a forum thread from 2019 has me more confused than ever! In 2019 a response from a poster that I have seen on the forum MANY times and trust what they have to say was "If the patient received the full physical plus the pelvic use the Z00.00 and the Z12.4 since you cannot code both Z00.00 and Z01.419 together on the same claim. In addition we always link the Z00.00 to the preventive code and then add a Q0091 for the Pap and link to the Z12.4 for all payers and we have no issues with reimbursement."

My issue with that is we seem to not have a lot of luck with reimbursement for Q0091 BUT have never used Z12.4 as the dx code. Does anyone have any insight?

 

[csperoni]

Z12.4 for cervical cancer screening is an appropriate and payable diagnosis with Q0091 FOR THE PAYORS THAT RECOGNIZE AND PAY FOR Q0091.
Unfortunately, this is really a carrier driven issue and you will need to find out from your carriers their individual policy.
Q0091 is essentially a Medicare code that some other payors do acknowledge and pay for. Some carriers will always bundle Q0091 with preventive 99384-99397 or E/M 99202-99215 regardless of modifiers. Some will pay separately only if -25 on visit and/or -59 on Q0091. At least that is the case for the payors I deal with.