Billing for Pap Smears - PCP vs OBGYN

I have a claim for a papsmear that was denied by an insurance stating that "due to the provider being a PCP, the coding was inconsistent and denied". The insurance rep stated that only an OBGYN can bill this way. The codes used were the following: 99395 - 25 modifier and 88142. Therefore, my question is...what is the appropriate way for a PCP to bill for a visit that is meant for the patient to have a pap smear done?

Thank you.

Hummm

I see no reason to bill with modifier 25. Did you use V72.31 as ICD-9? 99395 is a well visit and 88142 is the lab charge for the pap so those make sense.
By any chance is it an insurance that makes the patients see a gyne for well women care? Some HMO's capitate their gynes for this service.

Medicare and pap

Medicare: if your practice is just collecting and sending the pap smear out use
Q0091 with V76.2.

Coding for Pap Smear

First of all, look up my entry on this site about well-woman exams, search "WWE" and look for my post that explains in great deal about the ins-and-outs of WWE coding. The bottom line, depending on health plan, you can code a G0101 or S0610 or S0612 AND Q0091. Assuming that a breast and pelvic was done along with the pap smear. The code 88142 is for the lab to read the pap smear....I don't know any PCP that processes and reads paps.


Charlene Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS
Administrator, North Scottsdale Family Medicine
POMAA National Advisory Board (www.pomaa.net)
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Coding for pap smear

Which part of the claim did they deny? 99395 or 88142? The 88142 is done by the pathologist, but they should pay on preventive medicine exam, 99395.