Ob-Gyn Coding Alert

There are better choices that won't get you in trouble

If you're tempted to report 88141 or another cytopathology smear code when your ob-gyn performs a Pap smear, don't give in. They're usually part of another service.
 
"Generally, Pap smears are included in the E/M service," says Brenda Dombkowski, CPC, a coding specialist at Obstetric-Gynecology & Infertility Group in Cheshire, Conn. You would report +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]) or other cytopathology smear codes in this group for interpreting the Pap results, which a pathologist usually performs, she adds.

Pap smears are one of the most commonly done procedures in an ob-gyn office. In fact, there's a strong connection between early cancer detection and Pap smears, so testing patients is a high priority for ob-gyn practices. Nonetheless, coding for this service remains a confusing issue for many because they're not sure if they should bill it separately.

Beware: In particular, watch out for encounter forms that list the cytopathology codes for the physician to check off. This often leads the doctor to believe that carriers should separately pay him or her for performing the test. "The doctor taking the Pap smear is usually not the provider screening the smear," Dombkowski says. If this is the case in your practice, do not bill a lab charge (for example, 88141), she points out. Mind You G's and Q's for Medicare When a Medicare patient presents to your office for a Pap smear and pelvic and breast exam, you should report HCPCS codes Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) and G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination).

Don't forget: Medicare will pay for one Pap test every two years for low-risk patients and annually for high-risk patients. And you can report both Q0091 and G0101 with an E/M service as long as you can separately identify the service. If this is the case, you would append the E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

There are specific criteria the patient must meet to be considered high-risk. In fact, for a Medicare patient who is presenting for her annual Pap smear and meets the criteria for high risk, you should report V15.89 (Other specified personal history presenting hazards to health; other) in addition to a secondary code that details why she is considered high-risk. The secondary code must match one of the following diagnoses for the patient to be considered high-risk under Medicare:

 History of HIV (V08 or 042)
 History of sexually [...]