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CPT code 92015 the correct diagnosis 367.1 or 367.10 or 367.4 or 367.40

Alexis Posted Fri 25th of January, 2013 04:18:23 AM

Which is the correct diagnosis for cpt 92015 367.1 or 367.10 or 367.4 or 367.40

SuperCoder Answered Fri 25th of January, 2013 21:12:23 PM

It can either be 367.1 or 367.4 depending upon what is given in the operative report.

As far as 367.10 or 367.40 are concerned, both are invalid Diagnosis.

Alexis Posted Mon 28th of January, 2013 14:16:40 PM

I have a Insurance payer EMB&M Corporation by First Health CPT code Q0091 with Diagnosis V762 they do not accept this code and asked to bill another cpt code. What code should we bill because alot of ins. payer do pay this code?

SuperCoder Answered Mon 28th of January, 2013 18:05:30 PM

When one of these examinations/screenings is performed during a medical E&M visit code (e.g., CPT 99201 - 99215), the provider should determine if the work performed as part of HCPCS Q0091 would impact the level of E&M code billed. If yes, an increased level of E&M code should be used to report the services performed and HCPCS Q0091 should not be billed.
If a claim is submitted with both an E&M medical visit code and HCPCS Q0091, the medical E&M visit code will be denied. CMS chose to make HCPCS Q0091 the primary code in the NCCI code pair/bundle and to deny the medical E&M as included in HCPCS Q0091. Since this is order of CMS's NCCI bundle, the order cannot be reversed.
If HCPCS Q0091 is billed alone, the code may be reimbursed according to the patient's benefit. Note: HCPCS Q0091 reports obtaining, preparing and sending the specimen to the laboratory. The actual Pap smear code is billed and paid separately from the E&M code.

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