Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Screening Papanicolaou (Pap Smear) with Evaluation and Management Services Edit #: 305 Effective Date: 7/15/2013-12/31/2099 Status: Current Last Review Date: 2/7/2013 Edit Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) bundles into 99201-99205 (Initial outpatient evaluation and management services), 99211-99215 (Established outpatient evaluation and management services), 99217-99220 (Observation care discharge or initial observation care evaluation and management services), 99221-99239 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services 99281-99285 (Emergency Department, evaluation and management services), 99291-99292 (Critical care, evaluation and management services), 99304-99310 (Nursing facility care, new, subsequent and discharge, evaluation and management services), 99315-99316 (Nursing facility discharge day management) 99318 (Other nursing facility services, evaluation and management services), 99324-99328 (Domiciliary, rest home {e.g., boarding home}, or custodial care or care plan services, evaluation and management services), 99334-99337 (Domiciliary or rest home visit for the evaluation and management of an established patient ) 99341-99350 (Home services, new or established patient, evaluation and management services, 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) 99455-99456 (Work related or Medical disability evaluation and management services), 99460-99466 (Newborn care, initial and subsequent or in attendance, evaluation and management services), 99468-99469, 99471-99472, (Inpatient neonatal and pediatric critical care evaluation and management services), 99475-99480 (Initial and continuing intensive care services, for neonates or low birth weight infants, evaluation and management services), 99499 (Unlisted evaluation and management), 99381 (Initial comprehensive preventive medicine, new patient age younger than 1 year), 99382 (Initial comprehensive preventive medicine, early childhood, new patient {age 1 through 4 years}), 99383 (Initial comprehensive preventive medicine, late childhood, new patient {age 5 through 11 years), 99384 (Initial comprehensive preventive medicine, adolescent, new patient {age 12 through 17 years}), 99385 (Initial comprehensive preventive medicine, new patient 18 through 39 years), 99386 (Initial comprehensive preventive medicine, new patient, 40-64 years), 99387 (Initial comprehensive preventive medicine, new patient 65 years or older), 99391 (Periodic comprehensive preventive medicine, established patient age younger than 1 year), 99392 (Periodic comprehensive preventive medicine, early childhood, established patient {age 1 through 4 years}), 99393 (Periodic comprehensive Page 1 of 13
preventive medicine, late childhood, established patient {age 5 through 11 years}), 99394 (Periodic comprehensive preventive medicine, adolescent established patient {age 12 through 17 years}), 99395 (Periodic comprehensive preventive medicine, established patient 18-39 years), 99396 (Periodic comprehensive preventive medicine established patient, 40-64 years), 99397 (Periodic comprehensive preventive medicine, established patient 65 years and older), S0610 (Annual gynecological examination, new patient), S0612 (Annual gynecological examination, established patient) or S0613 (Annual gynecological examination; clinical breast examination without pelvic examination) CODE RULE CODE Q0091 Incidental 99201-99205 99211-99215 99217-99220 99221-99239 99281-99285 99291-99292 99304-99310 99315-99316 99318 99324-99328 99334-99337 99341-99350 99360 99455-99456 99460-99466 99468-99469 99471-99472 99475-99480 99499 99381-99387 99391-99397 S0610-S0613 Rationale for Edit: Anthem Central Region bundles Q0091 as incidental with 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99281-99285, 99291-99292, 99304-99310, 99315-99316, 99318 99324-99328 99334-99337, 99341-99350, 99360, 99455-99456, 99460-99466, 99468-99469, 99471-99472, 99475-99480, 99499, 99381-99398, 99391-99397 or S0610-S0613. Anthem Central Region considers screening services are part of performing an evaluation and management services and therefore not reimbursed separately. Therefore, if Q0091 is submitted with 99201-99205, 99211-99215, 99217-99220, 99221- Page 2 of 13
99239, 99281-99285, 99291-99292, 99304-99310, 99315-99316, 99318 99324-99328 99334-99337, 99341-99350, 99360, 99455-99456, 99460-99466, 99468-99469, 99471-99472, 99475-99480, 99499, 99381-99387, 99391-99397 or S0610-S0613 only 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99281-99285, 99291-99292, 99304-99310, 99315-99316, 99318 99324-99328 99334-99337, 99341-99350, 99360, 99455-99456, 99460-99466, 99468-99469, 99471-99472, 99475-99480, 99499, 99381-99387,99391-99397 or S0610-S0613 is reimbursable. References: 1. Anthem Blue Cross and Blue Shield. EPRP: #00036 Screening Services with Evaluation and Management Services. Enterprise Professional Reimbursement Policy. Pages 1-2. Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Screening Papanicolaou (Pap Smear) with Evaluation and Management Services Edit #: 305 Effective Date: 9/12/2008-7/14/2013 Status: Prior Last Review Date: 5/8/2008 Edit 99201-99205 (Initial outpatient evaluation and management services), 99211-99215 (Established outpatient evaluation and management services), 99217-99220 (Observation care discharge or initial observation care evaluation and management services), 99221-99239 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-99245 (Office consultation evaluation and management services), 99251-99255 (Inpatient consultation evaluation and management services-new or established), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-99285 and 99291-992300 (Emergency Department, critical care and neonatal and pediatric critical care services). 99304-99350 (Nursing facilities, Domiciliary, Rest Home and home care evaluation and management services) and 99455-99456 (Work related evaluation and management services) bundles with Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) 99201-25-99205-25 (Initial outpatient evaluation and management services), 99211-25-99215-25 (Established outpatient evaluation and management services), 99217-25-99220-25 (Observation care discharge or initial observation care evaluation and management services), 99221-25-99239-25 (Initial, Page 3 of 13
subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-25-99245-25 (Office consultation evaluation and management services), 99251-25-99255-25 (Inpatient consultation evaluation and management services-new or established), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-25-99285-25 and 99291--25-99300-25 (Emergency Department, critical care and neonatal and pediatric critical care services). 99304-- 25-99350-25 (Nursing facilities, Domiciliary, Rest home and home care evaluation and management services) and 99455-25-99456-25 (Work related evaluation and management services) does not bundle with Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) Q0091-59 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) does not bundle with 99201-99205 (Initial outpatient evaluation and management services), 99211-99215 (Established outpatient evaluation and management services), 99217-99220 (Observation care discharge or initial observation care evaluation and management services), 99221-99239 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-99245 (Office consultation evaluation and management services), 99251-99255 (Inpatient consultation evaluation and management services-new or established), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-99285 and 99291-992300 (Emergency Department, critical care and neonatal and pediatric critical care services). 99304-99350 (Nursing facilities, Domiciliary, Rest Home and home care evaluation and management services) and 99455-99456 (Work related evaluation and management services) does not bundle with Q0091-59 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) bundles with 99381-99397 (Preventive medicine services, new patient or established patient). Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) bundles with 99381-99397 (Preventive medicine services, new patient or established patient). CODE RULE CODE 99201-99205 99211-99215 99217-99220 99221-99239 99241-99245 99251-99255 99281-99285 99291-99300 99304-99350 99455-99456 99201-99205 99211-99215 Incidental Separate Reimbursement Q0091 Q0091 Page 4 of 13
99217-99220 99221-99239 99241-99245 99251-99255 99281-99285 99291-99300 99304-99350 99455-99456 99201-99205 Separate Reimbursement Q0091-59 99211-99215 99217-99220 99221-99239 99241-99245 99251-99255 99281-99285 99291-99300 99304-99350 99455-99456 Q0091 Incidental 99381-99397 Rationale for Edit: Anthem Central Region bundles 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99255, 99281-99285, 99291-99300, 99304-99350 and 99455-99456. Based on the National Correct Coding Initiative Edits, codes 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99255, 99281-99285, 99291-99300, 99304-99350 and 99455-99456 are listed as component codes to code Q0091. Therefore, if 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99255, 992841-99285, 99291-99300, 99304-99350 and 99455-99456 is submitted with Q0091 only Q0091 reimburses. Anthem Central Region does not bundle 99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99255-25, 99281-25-99285-25, 99291-25-99300-25, 99304-25-99350-25 and 99455-25-99456-25 with Q0091 and does not bundle 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99255, 99281-99285, 99291-99300, 99304-99350 and 99455-99456 with Q0091-59. Based on the 2008 HCPCS manual, which states: Q0091 may be reported with an E/M code when a separate identifiable E/M service is provided. To identify when a separate evaluation and management service is required to be submitted along with the Q0091service, append modifier 25 to the E/M service or modifier 59 to Q0091. Therefore, if 99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99255-25, 99281-25-99285-25, 99291-25-99300-25, 99304-25-99350-25 and 99455-25-99456-25 with Q0091 both the E/M service (99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99255-25, 99281-25-99285-25, 99291-25-99300-25, 99304-25-99350-25 and 99455-25-99456-25) and Q0091 reimburses separately; or if 99201-99205, 99211-99215, 99217- Page 5 of 13
99220, 99221-99239, 99241-99245, 99251-99255, 99281-99285, 99291-99300, 99304-99350 and 99455-99456. is submitted with Q0091-59 both E/M service (99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99255, 99281-99285, 99291-99300, 99304-99350 and 99455-99456.) and Q0091-59 reimburses separately. Anthem Central Region bundles Q0091as incidental with 99381-99397. Based on the CPT Assistant Coding Consultation Questions and Answers article, where it states: Evaluation and Management: Preventative Medicine Services, 99381, 99397 (Q&A) Question Is a pap, pelvic, and/or breast exam included in the appropriate preventive medicine service codes performed on the same date of service? Or should the pap, pelvic, and/or breast exam be reported in addition to the preventive medicine service codes (99381-99397). AMA Comment The codes in the preventive medicine services include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. The performance of immunization and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately. In 2005, the range of codes listed in the introductory notes for preventive medicine services referencing immunizations was revised to encompass new codes (90465, 90466, 90467, 90468) for immunization administration accompanied by counseling. The guidelines were revised strictly to identify the new immunization administration accompanied by counseling CPT codes. Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient. For example, E/M preventive services for a 28-year-old adult female may include a pelvic examination including obtaining a pap smear, breast examination, and blood pressure check. Counseling is provided regarding diet and exercise, substance use, and sexual activity. Therefore, based upon this information, it would not be appropriate to separately report for a pelvic exam including obtaining of the pap smear, nor the breast exam as these services are considered part of a comprehensive preventive medicine E/M services. Therefore, if Q0091 is submitted with 99381-99397 only 99381-99397 reimburses. Reference Information: Page 6 of 13
1. Centers for Medicare and Medicaid (April 1, 2008-June 30, 2008) National Correct Coding Initiative Edits-14.1. Retrieved, April 15, 2008, from the World Wide Web: http://www.cms.hhs.gov/nationalcorrectcodinited/ncciep/itemdetail.asp?filtertype=none&fil terbydid=- 99&sortByDID=2&sortOrder=ascending&itemID=CMS046553&intNumPerPage=10 2. American Medical Association. Questions and Answers-Evaluation and Management: Preventive Medicine Services, 99381-99397. CPT Assistant, 2005 (August ): page 15. Prior Version(s), if any, of this edit can be found below {Times New Roman 14} Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Screening Papanicolaou (Pap Smear) with Evaluation and Management Services Edit #: 305 Effective Date: 3/3/2006-9/11/2008 Status: Prior Last Review Date: 4/12/2007 Edit 99201-99205 (Initial outpatient evaluation and management services), 99211-99215 (Established outpatient evaluation and management services), 99217-99220 (Observation care discharge or initial observation care evaluation and management services), 99221-99239 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-99245 (Office consultation evaluation and management services), 99251-99255 (Inpatient consultation evaluation and management services-new or established), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-99285 and 99291-99298 (Emergency Department, critical care and neonatal and pediatric critical care services). 99301-99350 (Nursing facilities and home care evaluation and management services), 99381-99397 (Preventive evaluation and management-new and established) and 99455-99456 (Work related evaluation and management services) bundles with Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) 99201-25-99205-25 (Initial outpatient evaluation and management services), 99211-25-99215-25 (Established outpatient evaluation and management services), 99217-25-99220-25 (Observation care Page 7 of 13
discharge or initial observation care evaluation and management services), 99221-25-99239-25 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-25-99245-25 (Office consultation evaluation and management services), 99251-25-99255-25 (Inpatient consultation evaluation and management services-new or established), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-25-99285-25 and 99291--25-99298-25 (Emergency Department, critical care and neonatal and pediatric critical care services). 99301-- 25-99350-25 (Nursing facilities and home care evaluation and management services), 99381-99397 (Preventive evaluation and management-new and established) and 99455-25-99456-25 (Work related evaluation and management services) does not bundle with Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). CODE RULE CODE 99201-99205 99211-99215 99217-99220 99221-99239 99241-99245 99251-99255 99261-99263 (Deleted Codes) 99271-99275 (Deleted codes) 99281-99285 99291-99298 99301-99350 99381-99397 99455-99456 99201-25-99205-25 99211-25-99215-25 99217-25-99220-25 99221-25-99239-25 99241-25-99245-25 99251-25-99255-25 99261-25-99263-25 (Deleted Codes) 99271-25-99275-25 (Deleted Codes) 99281-25-99285-25 99291-25-99298-25 99301-25-99350-25 99381-25-99397-25 99455-25-99456-25 Incidental Separate Reimbursement Q0091 Q0091 Page 8 of 13
Rationale for Edit: Anthem Midwest bundles 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99263, 99271-99275, 99281-99285, 99291-99298, 99301-99350, 99381-99397, 99455-99456 or 99381-99397 as incidental with Q0091. Based on the National Correct Coding Initiative Edits, codes 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99263, 99271-99275, 99281-99285, 99291-99298, 99301-99350 and 99455-99456 are listed as component codes to code Q0091. In a 2005 CPT Assistant, Coding Consultation-Questions and Answers, article, where it states: article, it states: Evaluation and Management: Preventative Medicine Services, 99381, 99397 (Q&A) Question Is a pap, pelvic, and/or breast exam included in the appropriate preventive medicine service codes performed on the same date of service? Or should the pap, pelvic, and/or breast exam be reported in addition to the preventive medicine service codes (99381-99397)? AMA Comment The codes in the preventive medicine services include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. The performance of immunization and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately. In 2005, the range of codes listed in the introductory notes for preventive medicine services referencing immunizations was revised to encompass new codes (90465, 90466, 90467, 90468) for immunization administration accompanied by counseling. The guidelines were revised strictly to identify the new immunization administration accompanied by counseling CPT codes. Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient. For example, E/M preventive services for a 28-year-old adult female may include a pelvic examination including obtaining a pap smear, breast examination, and blood pressure check. Counseling is provided regarding diet and exercise, substance use, and sexual activity. Therefore, based upon this information, it would not be appropriate to separately report for a pelvic exam including obtaining of the pap smear, nor the breast exam as these services are considered part of a comprehensive preventive medicine E/M services. Therefore, if 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99263, 99271-99275, 99281-99285, 99291-99298, 99301-99350, 99455-99456 or 99381-99397 is submitted with Q0091 only Q0091 reimburses. Page 9 of 13
Anthem Midwest does not bundle 99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99263-25, 99271-25-99275-25, 99281-25-99285-25, 99291-25-99298-25, 99301-25-99350-25, 99381-25-99397-25 or 99455-25-99456-25 with Q0091. Based on the 2007 HCPCS Manual, Q0091 can be reported with an E/M code when a separately identifiable E/M service is provided. Append modifier 25 to the evaluation and management service (99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99255-25, 99281-25-99285-25, 99291-25-99298-25, 99301-25-99350-25, 99381-25-99397-25 and 99455-25- 99456-25) to show a separate identifiable service was required along with the performance of Q0091. Therefore, if 99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99263-25, 99271-25-99275-25, 99281-25-99285-25, 99291-25-99298-25, 99301-25-99350-25, 99381-25-99397-25 and 99455-25-99456-25 is submitted with Q0091 both the evaluation and management service and the obtaining of the pap smear (Q0091) reimburses separately. Reference Information: 1. Centers for Medicare and Medicaid (July 1, 2001-September 30, 2007) National Correct Coding Initiative Edits-version 11.2. Retrieved September 12, 2005 from the World Wide Web: http://www.cms.hhs.gov/physicians/cciedits/ 2. Centers for Medicare and Medicaid (January 1, 2007-March 31, 2007) National Correct Coding Initiative Edits-Version 13.0. Retrieved March 29, 2007 from the World Wide Web: http://www.cms.hhs.gov/nationalcorrectcodinited/ncciep/itemdetail.asp?filtertype=none&filterb ydid=-99&sortbydid=2&sortorder=ascending&itemid=cms046553&intnumperpage=10 3. American Medical Association. Coding Consultation: Questions and Answers---Evaluation and Management: Preventive Medicine Services, 99381, 99397 (Q&A). CPT Assistant. 2005 (August): page 15 Prior Version(s), if any, of this edit can be found below {Times New Roman 14} Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Screening Papanicolaou (Pap Smear) with Evaluation and Management Services Page 10 of 13
Edit #: 305 Effective Date: 09/09/2001-03/02/2006 Status: Prior Last Review Date: 05/10/2001 Edit Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is redundant/mutually exclusive with 99201-99205 (Initial outpatient evaluation and management services), 99211-99215 (Established outpatient evaluation and management services), 99217-99220 (Observation care discharge or initial observation care evaluation and management services), 99221-99239 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-99245 (Office consultation evaluation and management services), 99251-99263 (Inpatient consultation evaluation and management services), 99271-99275 (Confirmatory consultation evaluation and management services), 99281-99285 and 99291-99298 (Emergency Department, critical care and neonatal and pediatric critical care services). 99301-99350 (Nursing facilities and home care evaluation and management services), 99381-99397 (Preventive medicine evaluation and management services) and 99455-99456 (Work related evaluation and management services). Q0091 (Screening Papanicolaou; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) does not bundle with 99201-25-99205-25 (Initial outpatient evaluation and management services), 99211-25-99215-25 (Established outpatient evaluation and management services), 99217-25- 99220-25 (Observation care discharge or initial observation care evaluation and management services), 99221-25-99239-25 (Initial, subsequent, observation or inpatient care or hospital discharge evaluation and management services), 99241-25-99245-25 (Office consultation evaluation and management services), 99251-25-99263-25 (Inpatient consultation evaluation and management services), 99271-25- 99275-25 (Confirmatory consultation evaluation and management services), 99281-25-99285-25 and 99291--25-99298-25 (Emergency Department, critical care and neonatal and pediatric critical care services). 99301--25-99350-25 (Nursing facilities and home care evaluation and management services), 99381-25-99397-25 (Preventive medicine evaluation and management services) and 99455-25-99456-25 (Work related evaluation and management services). CODE RULE CODE Q0091 Redundant/Mutually Exclusive 99201-99205 99211-99215 99217-99220 99221-99239 99241-99245 99251-99263 99271-99275 Page 11 of 13
Rationale for Edit: 99281-99285 99291-99298 99301-99350 99381-99397 99455-99456 Q0091 Separate Reimbursement 99201-25-99205-25 99211-25-99215-25 99217-25-99220-25 99221-25-99239-25 99241-25-99245-25 99251-25-99263-25 99271-25-99275-25 99281-25-99285-25 99291-25-99298-25 99301-25-99350-25 99381-25-99397-25 99455-25-99456-25 Anthem Central Region bundles Q0091 as redundant with 99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99263, 99271-99275, 99281-99285, 99291-99298, 99301-99350, 99381-99397 and 99455-99456. Based on a CPT Assistant article: pelvic exams are considered to be a component of evaluation and management services: "Several procedures that do not have separate CPT codes are included when an E/M code is reported. These include, for example, gastric intubation {passage of a nasogastric tube} and a pelvic examination without anesthesia. Gastric intubation and aspiration or lavage for treatment {e.g., for ingested poisons} is reported using code 91105. Reporting 91105 indicated that the physician passes a nasogastric tube and aspirates the contents of the stomach or lavages the stomach. Placing a nasogastric tube into the stomach only is not coded separately from the E/M service. A pelvic examination under anesthesia is reported using code 57410. A pelvic examination performed without anesthesia is not coded separately, it is included in the evaluation and management code reported for the visit." Therefore, if Q0091 is submitted with evaluation and management services (99201-99205, 99211-99215, 99217-99220, 99221-99239, 99241-99245, 99251-99263, 99271-99275, 99281-99285, 99291-99298, 99301-99350, 99381-99397 and 99455-99456)--only the evaluation and management service will reimburse. Anthem Midwest does not bundle Q0091 with 99201-25-99205-25, 99211-25-99215-25, 99217-25- 99220-25, 99221-25-99239-25, 99241-25-99245-25, 99251-25-99263-25, 99271-25-99275-25, 99281-25- 99285-25, 99291--25-99298-25, 99301-25-99350-25, 99381--25-99397-25 and 99455-25-99456-25. Based on the 2003 HCPCS Level II manual, under code Q0091, it states: "Q0091 can be reported with an E/M code when a separate identifiable E/M service is provided. Therefore, if Q0091 is submitted with Page 12 of 13
an E/M (99201-25-99205-25, 99211-25-99215-25, 99217-25-99220-25, 99221-25-99239-25, 99241-25- 99245-25, 99251-25-99263-25, 99271-25-99275-25, 99281-25-99285-25, 99291--25-99298-25, 99301-25-99350-25, 99381-25-99397-25 and 99455-25-99456-25)--both will reimburse separately. Reference Information: 1. American Medical Association. Procedures Included with Evaluation and Management Codes. CPT Assistant; Spring 1993; 3(1): 34-35. Page 13 of 13