Wiki Billing E/M vs. Preventive CPT for annual pap smear visits

Create Wiki
Y

yvonnec

New
Messages
1
Location
San Antonio, TX
Best answers
0
Hi can someone explain to me why a FQHC would bill an E/M, level 3 for an annual exam and pap smear vs. 99385 or 99395? I just started working at this facility and I found this weird. we never did this in private practice. this is the response we got from the "higher ups":

I actually prefer that he use the regular E&M codes as opposed to the preventative codes, because we tend to run into issues with some of the payers if those preventative codes don?t match up with the Dx codes they have loaded into their payment processing system. We?ve never had payment issues because of this particular coding usage.

Can anyone chime in? Please help.
 
I don't know why they would code a level 3 visit vs 9938_ or 9939_ when the main reason for the visit is the PE. And they're not billing Q0091 w/V76.2 for the pap? Are the providers also doing a sick visit at the time of the PE? We bill for both w/25 mod on the E&M if that's the case. Some insurances will cover both & some may with a written appeal & office notes backing the visits up.

If the providers are billing 99203 or 99213 w/V70.0 or V72.31 then the insurances will deny.

Medicare will only pay one PE per year with G0402 (welcome to Medicare w/in 12 mos of pt B elig), G0438 (new pt) or G0439 (estab pt). Some Medicare replacements like those HCPCS codes too, but a call to your provider rep should help you figure which ones like 9938_ or 9939_ vs G codes.

Hope this helped :) Maybe someone else can give some extra insight!
 
You must log in or register to reply here.
Top