Wiki Can we code/bill for Q0091 with preventative code

[missbren71]

So I have read alot of threads about using the Q0091 with the G0101 and then it sounds iffy to use the Q0091 with Preventative E/M codes. I work at the VA and haven't got alot of females until recently and would like more guidance from coders that work in the OB/GYN arena and have seen these bills get reimbursed and know the guidelines on this. Any help would be greatly appreciated. It really should be cut and dry but it never seems to be. Also any links to references would be so appreciated also.

Preventative E/M with Q0091 (no signs or symptoms)- yes or no

Thanks so much

 

[lscott]

Is this for a Medicare, Medicaid, or commercial patient? SC Medicare will allow you to bill the preventive code with a modifier with Q0091 and G0101, but they will not pay the preventive code, the patient is responsible. Then you have to reduce the amount owed by the patient by the amount paid for the pap and breast/pelvice exam. It gets very tricky! We tried it, made a lot of patients upset over the billing, and finally stopped billing the preventive code and only bill the pap, breast/pelvic, ua, and stool if done.


Lisa

 

[Charlotte Cooner Reed]

Medical Reimbursement

Is it appropriate to bill Q0091 with preventive medicine code using the guidleines provided by CPT-HCPCS regardless of insurance type?

 

[missbren71]

Thanks...this would be a non medicare pt please.

 

[anthemfamily]

no Q0091 is inclusive in the e&m for commercial payors. Many will initially pay and then come back to recoup.

Traci, CPC

 

[01065679]

Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

So I have read alot of threads about using the Q0091 with the G0101 and then it sounds iffy to use the Q0091 with Preventative E/M codes. I work at the VA and haven't got alot of females until recently and would like more guidance from coders that work in the OB/GYN arena and have seen these bills get reimbursed and know the guidelines on this. Any help would be greatly appreciated. It really should be cut and dry but it never seems to be. Also any links to references would be so appreciated also.

Preventative E/M with Q0091 (no signs or symptoms)- yes or no

Thanks so much

This came from a BC/BS policy...
Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

We would like to take this opportunity to remind providers that obtaining a Pap smear is integral to the office visit, including both preventive and routine office visits. Separate reimbursement is not allowed for HCPCS code Q0091.

According to the American Congress of Obstetricians and Gynecologists, code Q0091 should not be reported to non-Medicare payers for Pap smear collection, as the collection of a Pap smear is included in the E&M or preventive service.

The Q0091 code was developed by Medicare for the exclusive purpose of reporting services provided to Medicare patients. Providers should report this code to Medicare only for the collection of screening Pap smears for Medicare patients.

 

[Leandra]

I would also check the ACOG website; they have information specific to this issue.