insurance company changing code

An insurance company on their own changed a Q0091 on our claim submission to an 88142 and dropped this to patient responsibility. Their comment was q codes are Medicare only, and "why were we even using them"? The company is a smaller company using the pricing and network of a large commercial insurance company which DOES pay q codes. Two questions: can an insurance company on their own change the cpt code submitted to a different cpt code, ( also, I was under the impression that the 88142 they changed to was only to be billed by pathologists), and 2) are they not obligated to recognize the cpt codes and pricing of "the network benefits applied -- negotiated rate in accordance with the provider agreement" of the larger company that does pay the Q0091? Thanks!

The insurer is clearly confused

The Q0091 is for conveyance of the pap to the lab; 88142 is for the interpretation of the pap. If you are billing for the interpretation of the pap (pass-thru billing) then the Q0091 should be bundled into the 88142. If the lab bills for the interpretation and the insurer changes your Q0091 to 88142 the lab is going to be denied when they submit their bill. So you need to sort out what you are billing for and then go to the insurer to fight this.

insurance is wrong

Thank you -- we are a family practice and bill only for the collection and conveyance to the lab -- the code the insur. co. changed to pays significantly less than the Q0091. We are in the process of fighting this and your input will help. The same company tried recently to double adjust a claim -- first applying the adjustment fee of the larger network correctly per contract, then further adjusting that amount with their own adjustment. We successfully fought that double adjustment. Now they are just switching cpt codes on their own to pay a lower amount.

Really??

It is hard to imagine that they pay better to drop a vial in a bag and print a lag form than to actually analyse the specimen and determine if cancer is present. What a backwards system we have! Why do we let insurance companies control our health care system? Nationalize health care and get them out of the system. We will all be healthier.