Wiki Q0091 Not Paid

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julieclifton2011

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Can anyone out there help we with this. I am getting denials for Q0091 from BCBS saying that this code is a Medicare and Medicade code only and will not pay. They will also not pay for the 99000 code.
I am not aware of any other code to use. I would appreicate any help, I have a stack of denials I need to try and rebill.
I was at a seminar in Feb. and was assured that this Q0091 was the code to use if you were getting denied on 99000. Now I am really :confused:



Thanks so much,:)
 
juliejenkins2005 said:
Can anyone out there help we with this. I am getting denials for Q0091 from BCBS saying that this code is a Medicare and Medicade code only and will not pay. They will also not pay for the 99000 code.
I am not aware of any other code to use. I would appreicate any help, I have a stack of denials I need to try and rebill.
I was at a seminar in Feb. and was assured that this Q0091 was the code to use if you were getting denied on 99000. Now I am really :confused:



Thanks so much,:)
Click to expand...

88142/90, is what we bill when we send it out to be read. Most commercial payers deny Q0091 with a well check - I know that Aetna and UHC do, as well. Hope that helps! ;)
 
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juliejenkins2005 said:
What is the /90 sorry I have never seen that?

Very thankful for your response so quickly :):):)
Click to expand...

90 modifier - "Outside/reference laboratory" It just means that someone else actually interpreted the lab, and all you did was take the specimen.

(Fun fact: Aetna requires it on 88142, if you're not a lab.)

Hope that helps!;)
 
It helps very, very much. So just so I have this right. My Q0091 should still work for my Medicare and Medicade and rthe 88142 with the 90 modifier should work on all the comm. insurance?
 
You got it!:D

But I wouldn't say "all" commercial payers...check on Tricare - they're the odd one out most of the time, and they tend to follow Medicare's rules.
 
Thanks sooooooooooooooooo much for helping me fix a big problem:) I really do appreicate it. Have a wonderful day:D

Thanks again ;)
 
The 88142 is a lab code for the lab to use for the preparation of the slides for the pathologist. It is not a code for the doc to use to perform the pap and pelvic exam. To obtain the pap is part of the visit level.
 
mitchellde said:
The 88142 is a lab code for the lab to use for the preparation of the slides for the pathologist. It is not a code for the doc to use to perform the pap and pelvic exam. To obtain the pap is part of the visit level.
Click to expand...

I would like some more imput on this. I am collecting the pap in the office and then sending it to a outside lab. I don't feel that it should be part of the visit.

Thanks for any thoughts
:)
 
Are you using a ThinPrep pap kit? I hadn't considered that not everyone uses those:eek:...
You can find the coverage criteria for BCBS here (from all over, but it's usually similar from state to state on this kind of stuff):

This one has the best shot of giving you the answer you need:
https://www.bluecrossca.com/provider/nv/f5/s5/t1/pw_b130805.pdf

Here are some others:
http://www.bcbstx.com/health/pdf/53714_tx_adult_w_guidelines.pdf

http://medicalpolicy.hcsc.net/medic...ICY/data/MEDICINE/MED207.092_2008-04-01#hlink

http://www.bcbsnm.com/pdf/pcgs_provider.pdf

Here's one on 99000 for you too...
http://www.bcbsnm.com/pdf/provider_ref_manual/section13.pdf
"Laboratory services are reimbursed at a fee-for-service rate according to the BCBSNM maximum allowable fee schedule. The handling or drawing of the specimen is considered part of the laboratory procedure; therefore, an additional charge for drawing or handling will not be reimbursed. However, BCBSNM will reimburse the provider for drawing or handling when the specimen is sent to a laboratory other than the provider's office lab and the laboratory procedure is billed separately by the independent laboratory. Bill with procedure code 36415 (for routine venipuncture) or procedure code 99000 (for handling) when appropriate, but not both. Handling codes are pended for review by Health Services."
 
Correct Reporting of HCPCS Code Q0091 for Pap Smear Collection

julieclifton2011 said:
Can anyone out there help we with this. I am getting denials for Q0091 from BCBS saying that this code is a Medicare and Medicade code only and will not pay. They will also not pay for the 99000 code.
I am not aware of any other code to use. I would appreicate any help, I have a stack of denials I need to try and rebill.
I was at a seminar in Feb. and was assured that this Q0091 was the code to use if you were getting denied on 99000. Now I am really :confused:



Thanks so much,:)
Click to expand...

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.
 
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