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.
 
vidraj said:
Hello, for BCBS, is anyone continuing to submit the CPT 88142 with modifier 90?

Click to expand...
Why are you asking this and attaching it to an older thread about Q0091? The policy you link gives you codes you can bill which includes Q0091), but why would you bill a lab code if you did not perform the test? Let the lab take the brunt of payment or non-payment for the service. Also, if you bill the lab code, you will probably get a denial for Q0091 since payers consider the collection of specimen part of the lab code billed.
 
vidraj said:
Hello, for BCBS, is anyone continuing to submit the CPT 88142 with modifier 90?

Click to expand...
If you are billing for an independent laboratory and the services being provided are best described by 88142-90, I do not see anything in the BCBS policy that states or even hints otherwise.
If you are not billing for an independent laboratory performing 88142, then regardless of BCBS policy, you should not bill a service not performed.
And yes, this definitely should have been a new thread instead of attaching to a barely related thread from 11 years ago.
 
Thank you both for your inputs. Just to clarify this is for Physician billing and provider had suggested 88142.

And, I was deparately looking for an answer to clarify and found this one with both the codes and posted it in a hurry.

Sorry, I will start a new thread next time.I was not aware I cannot post in these old threads.
 
vidraj said:
Thank you both for your inputs. Just to clarify this is for Physician billing and provider had suggested 88142.

And, I was deparately looking for an answer to clarify and found this one with both the codes and posted it in a hurry.

Sorry, I will start a new thread next time.I was not aware I cannot post in these old threads.
Click to expand...
Regarding posting - it's a best practice and most likely for your question to be seen and replied to if you post either:
1) In a recent thread with your same/very similar issue and you are seeking additional clarification
2) If that doesn't apply, then a new thread

Regarding your question - it is not impossible for an obgyn to be providing the service described in 88142, but it is extremely unlikely. It is not the collection. It is actually analyzing the smear. In my suburban NY area, I have never seen an obgyn do this in 30+ years. Maybe if you're in an extremely rural area without access to a lab. As a coder, anytime a code is suggested to you, I recommend reading the actual description and any additional information you can find. If you need clarification, discuss it with the physician suggesting the code. Most physicians are not coders and as soon as you discuss what this code actually entails, they would likely agree this is not something they are performing. Modifier -90 is specifically for an independent lab, which you are stating you are not.
88142 - The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer preparation for the specimen followed by manual screening under a physician’s supervision. The test may apply to any reporting system, such as Bethesda or non–Bethesda.
 
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