Internal Medicine Coding Alert

Question: Should I report an office visit in addition to a repeat Pap smear?


Massachusetts Subscriber

Answer: Whether you should code an E/M service in addition to the collection of another Pap smear specimen depends on what the encounter entailed.

A visit for a repeat Pap smear often involves more than just the procedure. The internist may discuss the patient's current health status and/or answer any questions that she may have.

In this case, you should report the office visit, such as 99212 (Office or other outpatient visit for an established patient ...). To indicate the service is significant and separate from the Pap smear collection, Medicare requires you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service. You should link 99212-25 to 795.08 (Unsatisfactory smear).

But if the patient returns for a "re-Pap" due to an unsatisfactory smear and the physician performs no additional service, you should not report the office visit. Instead, charge only the collection.

To Medicare and other carriers that recognize the HCPCS level-II Pap smear code, report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).

Indicate a repeat Pap smear by attaching modifier 76 (Repeat procedure by same physician) to Q0091. Otherwise, use 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). Report Q0091-76 or 99000 with one of these V codes:

• V76.2--Special screening for malignant neoplasms, cervix
• V76.47--... vagina
• V76.49--... other sites.

Clarification: The last sentence of October 2005's Internal Medicine reader question "Try Q0091-76 With Private Payers" suggests reporting the E/M encounter, such as 99212, with 795.08. The recommendation assumes that the internist provides a separate and significant office visit from the Pap smear recollection. You should not automatically charge an E/M service in addition to a repeat Pap smear.