Author Topic: How can I get Q0091 paid when it is bundled?  (Read 1354 times)

Michele

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How can I get Q0091 paid when it is bundled?
« on: March 14, 2008, 08:29:34 AM »
Question
Do you know if there is anything that can be done to get the Q0091 paid when it is being denied for bundled when billed with 99396-25. Most insurances are denying the Q0019 for bundled. Any ideas on what can be done to get it paid?
Thanks
Miriam

Answer
Hi Miriam,
Are you billing the Q0091 with a dx of V72.31? According to CMS, they allow a screening pap smear for low risk beneficiaries with the dx V72.31 every 2 years, and high risk beneficiaries they allow a screening pap every year. If you have not been using the V72.31, try that on the line for the pap. Let me know how it works out for you.
Michele

Question

I billed with the Q0091 with the V7231 and it still got denied. Should I have put a modifier 25 on the exam?

Answer

Hi Miriam,
I double checked the Upstate Medicare website to make sure I had the info right and it was. What state are you in? I would have thought the 25 modifier would have worked but if they are bundling the pap in with the office visit code then it isn't working. I would suggest that you call Medicare on a specific patient's denial and ask them why the pap is not being allowed separately. Please let me know, Iím very curious as to what they will tell you.
Thanks
Michele
« Last Edit: March 14, 2008, 09:06:00 AM by Michele »
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Michele

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Re: How can I get Q0091 paid when it is bundled?
« Reply #1 on: March 14, 2008, 09:03:41 AM »
Miriam's Response
I am in Florida. Medicare is paying the Q0091, however it is the commercial insurances that I am having a problem with. I am billing with a modifier and the V7231 DX. I have appealed a couple but I have not gotten a response back.
Thanks for your help. It is much appreciated.
Miriam

Michele's answer
Hi Miriam,
If it is commercial insurance carriers that are denying the claims I would try to contact your provider rep for at least one of the major ones. They should be able to tell you why it is being bundled in with the well visit. I am hearing more and more of this happening. It seems to be a way for some insurance carriers to save money. Most offices don't have the time or resources to research why it's happening. They just accept the payment. In fact, I just wrote up an entry in my blog on this exact topic. It might be worth a phone call.
Good luck
Michele
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patbaylon

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Re: How can I get Q0091 paid when it is bundled?
« Reply #2 on: March 16, 2008, 10:24:57 PM »
v72.31 shold not be reported with the QOO91...Notice that the ICD-9 code V72.31 (gynecological exam) is not used to report Medicare screening services. Instead, one of the following ICD-9 codes is used:

V76.2 Special screening for malignant neoplasms, cervix (patient who has an intact cervix or uterus)

V76.47 Special screening for malignant neoplasms, vagina

V76.49 Special screening for malignant neoplasms, other sites OR

V15.89 Other specified personal history presenting hazards to health (patient who is considered high risk according to Medicare's criteria).

Modifier -GA is appended to the HCPCS codes to indicate that the patient has signed an advanced beneficiary notice (ABN). Medicare screening services can be reported annually if the physician does not know when the last covered screening service was provided. If it is not a covered year, Medicare will deny the service and the patient can be held responsible for payment. The patient can be charged only if an ABN has been signed.