Ob-Gyn Coding Alert

The wrong diagnosis could cost you $44 per patient.

Pap smear results can return as abnormal for various reasons. Atypical Squamous Cells of Undetermined Significance (ASCUS), Atypical Glandular cells of Undetermined Significance (AGUS), or an inflammatory condition present when the smear was collected can affect the results. If the patient has an inflammation, such as acute vaginitis (N76.0), that affects the results of the Pap smear, the physician likely will treat the condition and perform another smear once the problem has resolved.

Think you aced the repeat Pap smear coding challenge on page XX? Check your answers against our experts’.

Answer 1: Zero In on These CPT^® Codes

When the patient comes in for a second Pap smear, submit the appropriate E/M office visit code (99211-99215), says Lillian Boyanton, CPC, coder at AWS Physicians in Atlanta, Ga.

“You should report a problem visit code, because this visit is no longer routine,” points out Cathy Satkus, CPC, coder at Harvard Family Physicians in Tulsa, Ok. You willprobably be able to report 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) for this visit because the patient likely will come in only for the Pap smear, and CPT^® does not include a specific code for taking the Pap.

Code 99212 carries 1.22 relative value units (RVUs), unadjusted for geography. That translates to about $44 for this visit (using the conversion factor of 35.8043).

Answer 2: Payer Determines Specimen Handling

Some private payers will reimburse for handling the repeat Pap smear specimen (99000, Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory). But Medicare carriers consider the collection and handling part of a problem E/M service, and you should not code for it separately.

In addition, Medicare will not reimburse for Q0091 (Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory) for the repeat Pap smear because it is a diagnostic test. In this case, Medicare considers the service a problem E/M, not a preventive screening, and the specimen collection is part of the E/M service.

Answer 3: Use R87.61- for Abnormal Results

You should report R87.61- (Abnormal cytological findings in specimens from cervix uteri…) if the ob-gyn repeats the Pap smear due to abnormal results. This code requires a sixth character, points out Peggy Stilley, CPC, CPC-I, CPMA, CPB, COGBC, revenue integrity auditor in Norman. If you don’t include the sixth character, this “could be a reason for a denial,” she adds.

For example, a 35-year-old woman with multiple sexual partners presents for an annual exam. She has not had a Pap smear in four years. The Pap results return ASC-US, and the physician asks her to come back in three months for a repeat Pap to follow any abnormal cell progress. When the patient returns, you should code the appropriate E/M office visit with R87.610 (Atypical squamous cells of undetermined significance on cytologic smear of cervix [ASC-US]) because the Pap is repeated due to abnormal cells.

Answer 4: ‘Inadequate Sample’ Means a Different Code

On the other hand, if the patient requires a second Pap smear because the first sample was inadequate (that is, the lab did not have enough cells in the specimen to interpret the results), you need to “report the appropriate diagnosis,” says Shannon McKendall, CPC with TUMG Business Services. You can use one of two codes. Report Z12.4 (Encounter for screening for malignant neoplasm of cervix) or R87.615 (Unsatisfactory cytologic smear of cervix) if the first smear was inadequate.

In the notes associated with R87.615 (Unsatisfactory cytologic smear of cervix), the ICD-10 manual indicates you can use this code for “unsatisfactory smear.” For example, the patient is menopausal and the physician does not reach the transformation zone. The Pap result indicates only a few cells (not enough to analyze), and the physician likely would require another Pap. The physician may consider this as just a second screening Pap smear, or may decide to report the available code for an unsatisfactory smear instead. Medicare would require Z12.4 (Encounter for screening for malignant neoplasm of cervix) as the code for this situation.

Medicare would then allow you to bill Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with a modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) for the second Pap smear.