Routine Pap smear

I have a claim that is being denied because of the codes I am using are wrong. The patient has routine coverage but they are saying the codes I am using do not fall under routine care.

Patient came in for her annual pap smear I billed dx code V72.31 CPT® Code 99395, P3001, and 99000. We never get reimbursed for the 99000 but I never have had a problem with the other two codes. Can someone help me with a different code that I should bill with?

Thank you and God bless!

re: Routine Pap smear

Is this a commercial insurance or Medicare? Is your physician reading the pap smear?

while many insurances are now adding preventive care due to Obamas health care reform, they are following the USPTF guidleines, who have not included the 993xx codes.

You may want to call the insurance plan and ask if the preventive visit 99395 is indeed covered. As for the other codes, I don't know of anyone who uses those anymore.

(and if you never get reimbursed for the 99000, why do you still bill it?)

re: Routine Pap smear

I called the insurance back and spoke with a different person and he stated that the patient does not have preventive care coverage at all. The insurance is Western Growers(commercial). If her plan had preventive coverage seleveted then she would be covered at 100%.

Thank you for all you help!

God bless!

[Is this a commercial insurance or Medicare? Is your physician reading the pap smear?

while many insurances are now adding preventive care due to Obamas health care reform, they are following the USPTF guidleines, who have not included the 993xx codes.

You may want to call the insurance plan and ask if the preventive visit 99395 is indeed covered. As for the other codes, I don't know of anyone who uses those anymore.

(and if you never get reimbursed for the 99000, why do you still bill it?)]

re: Routine Pap smear

Interesting that they are able to skirt the federal mandate (while it is still in force)...

re: Routine Pap smear

The person that I spoke with the last time at the insurance stated that it was an option that the patient made to opt out of...but when I called and spoke with the patient she stated she had no idea what was or was not covered on her plan. I told her to research her policy because preventive medicine was not covered on her plan.

This patient has been with the insurance since 2006 could that be why they are able to do this and her not have preventive coverage?!?!