I have a few patients who calls and complains because they have received a bill from the labs showing they owe money. the patient was seen in our office for their yearly Preventive exam in which I would bill out the 99385-99397 with the Z01.419 (Encounter for gynecological examination (general) (routine) without abnormal findings). I have learned that on the providers side when they submit the Lab codes they are using things like R87.612 (Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)) because in the previous years the patients labs came back abnormal; as for when they have their colpo in the previous year.

So because the provider is putting a problem diagnosis on the lab claim this is where the patients bill is coming from.

I would like to know is this correct billing when submitting claims to the lab??? Or should they be using Z01.411 (Encounter for gynecological examination (general) (routine) with abnormal findings) because we truly do not know if the patient is reflecting positive until the labs come back for this year.

Thanks in advanced

Bev