Author Topic: S0612 / Q0091  (Read 77 times)

jenniferp

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S0612 / Q0091
« on: November 13, 2020, 02:29:56 PM »
HELP ????

Patient comes in for "problem" visit for diabetes and hypertension, but it also due for her pap.  We do her pap and bcbs is denying as bundled, we billed 99214-25 for visit and then S0612 annual gyn exam.  Should we have billed the Q0091?  We are PCP office.

Does anyone else have any info on pap billing?

Thanks -
Jennifer

Michele

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Re: S0612 / Q0091
« Reply #1 on: November 17, 2020, 01:08:14 PM »
Did you have the diabetes & hypertension dxs listed for the 99214?  What dx did you have for the S0612? 
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jenniferp

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Re: S0612 / Q0091
« Reply #2 on: November 18, 2020, 02:43:41 PM »
Yes -- dm and htn were on the 99214, for the S0612 we had Z12.4 and/or Z01.419 for gyn / cervical exam.

Here's our dilemma......patient comes in for annual physical....we bill the "physical" (ex. 99395) code and clm is processed.  Patient then calls us and says I need my pap smear done.  We can't bill another "physical/well woman" exam because we've already billed it.  So, we bill an E/M and bill the Q0091 or S0612 code along w/it.  Problem is, some insurance companies cover one or the other, some don't cover it at all.

We're confused on how we should handle these if the patient doesn't tell us they need a pap smear.  Should we start asking every female patient that comes in for an annual physical if they need their pap smear and do it along w/the physical?  Can we bill either the Q or S codes with the physical?  Should we continue doing the physical and pap on separate dates of service?

I'm wondering this........if I'm allowed by my insurance company to have an annual physical and go to my PCP for that and I'm allowed a well woman exam every year and go to my OBGYN do they both get paid because their done by separate providers?

Sorry for the rambling......we're at a loss.

Jenn


Michele

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Re: S0612 / Q0091
« Reply #3 on: November 22, 2020, 06:13:48 PM »
This is a predicament.  It's easy for me to say "Yes, ask each female if they need a pap" but I realize that's not always practical.  However, if you don't you have a billing issue. 

I used to go to my PCP for my annual physical and my GYN for my annual pap/physical.  I believe they were both paid, so I'm thinking you are right, if they are done by separate drs, they are allowed.  But I think most insurances do not allow them separately if done by the same dr.
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