pap/gyn

I work for a PCP office and we have majority all Medicaid HMO plans, what code to use to get paid?? It used to be that for these plans you billed the age level appropiate E/M code with diagnosis V72.31.

They for some reason they are rejecting this. I have looked into code G0124 with keystone mercy which means Pap smear, and they do pay on this. But not all Medicaid HMO's are. Is there a universal code that someone knows of. Oh i am in the state of PA which I swear codes are hard at times to get paid.

pap smears

The code you are using is for the payment of the actual testing of the smear. Are you testing these in office or sending them to the lab? If you are sending them out this is the code the lab would use. If you have used this code more than likely the insurance companies will recoup this amount from you because the lab wil bill for this service too. Try using Q0091 for the pap or if it is a well woman exam use G0101 if all components of that code are met. These codes can be tricky read the code carefully to see if that is the service that was actually provided. The coding for Medicaid often follows Medicare guidelines.Try using icd 9 code V76.2 also. This is also a really good reference: http://www.cms.hhs.gov/MLNProducts/d...nceChart_1.pdf