# Pap Smear question



## apierce16 (Feb 11, 2014)

MMOH has recently notified  one of our providers that they are taking back all payments on cpt code # 88141/Q0091 with preventive services. Question: what do we use then and what if a patient is not coming in for a pap but is having issues and the doctor needs to obtain a smear for the laboratory. What would I code? Please help in any way. Coder from Oh-io!


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## hjchamas (Feb 11, 2014)

In my experience 88141 is a reflux code for the 88175 that has come up abnormal in lab, so a pathologist has to look at it. By its definition 88141 is an abnormal code and cannot be used with a routine diagnosis. If the patient has an abnormal hx and is coming in for a pap. I would use 88175 with an abnormal hx diagnosis.

Hope this helps!
Holly


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## mitchellde (Feb 11, 2014)

The 80000 codes are for the lab to use not the provider that obtains the specimens.  The performance of the pap is included with E & M.  If it is a well woman then you use the q0091


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## Nenna Bayes (Feb 11, 2014)

*January 2014 healthcare business monthly*

Pages 16 and 17 of the January 2014 issue of HealthCare Business Monthly may help you with this question.  I just skimmed over it and thought it may be help for you.


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## apierce16 (Feb 11, 2014)

*Pap Smear Question*

Thanks so much for both of your help. Saved me!


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## apierce16 (Feb 11, 2014)

*Pap Smear 2nd question*

I just realized I put 88141 instead of 88142 which is the problem code. Are you answers still the same?


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## apierce16 (Feb 11, 2014)

I just realized I put 88141 instead of 88142 which is the problem code. Are you answers still the same?


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## mitchellde (Feb 11, 2014)

the 8000 series CPT codes are for Lab and path use.  You do not use the codes in the OB/GYN office setting.  Some Dermatology providers do a lot of their own path and have the equipment to do this so they can and do use these codes.  However the average physician office setting you do not bill the lab codes.  If you feel you need to bill for the speciment transport then you can use the 99000 but mosdt payers do not pay this code.  The performing of the PAP and the collection of the speciment is included in the E&M


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## apierce16 (Feb 11, 2014)

mitchellde thank you for your response. Would this be for the same case for diagnostic if a patient comes in for a problem with no preventive (pap) being done and the doctor would have to take a sample/smear due to the illness the patient is having?


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## mitchellde (Feb 11, 2014)

yes for a symptomatic patient and a PAP is the appropriate exam, you just bill the E&M


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## PatriciaWright (Sep 30, 2014)

*Pap Smear*

Ok I am confused. We were told by our local chapter to use the Q0091 and the 88141 together. I was always taught that Q0091 was for Medicare and Medicaid, when did that change?


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## mitchellde (Sep 30, 2014)

The physician office will not use the 88141 unless you do all the lab work in your office.  The Q0091 was designed formMedicare but is allowed for other payer to use at their discretion it is not a Medicare only code, this has always been the case.


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## suemt (Feb 2, 2015)

Debra is correct, and I found this additional information from CPT Asst that might provide some more detail (see *BOLD* below.  

December 2011 page 17

Bonus Feature: Special Q&A:Laboratory and Pathology

Question 1: Based on the descriptor language "requiring interpretation by physician," may code 88141, Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician, be reported by the attending physician (eg, gynecologist) when medically indicated? Carolyn Kent, MBA, MT (ASCP)

Answer 1: From a CPT coding perspective, it is appropriate for a physician to report code 88141 for physician interpretation of a Pap test, which is interpreted as abnormal by personnel performing the initial screening, including those interpreted as showing suspicious or malignant cells, those showing epithelial cell abnormality (eg, atypical cells of undetermined significance), or cellular changes simulating epithelial cell abnormality such as repair, radiation effect, and cellular changes associated with viral infection. Negative Pap smears, including smears reviewed for quality control purposes that do not require physician interpretation, should not be coded with the physician interpretation code (88141).

*The basic professional requirement for the use of this code requires that the physician must be qualified to interpret the Pap test per the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA), personally evaluates the cytology preparation, and bases his or her interpretation on this microscopic evaluation. This service is typically performed by a pathologist. If, however, the patient's attending physician is appropriately qualified, he or she may provide and report this service.* As indicated in the introduction of the CPT codebook, it is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group.


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