Ob-Gyn Coding Alert

The wrong diagnosis could cost you $40 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 vaginitis (616.10), 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 11? Check your answers against our experts-.

Answer 1: Here's What CPT Codes You Should Use

When the patient comes in for a second Pap smear, submit the appropriate E/M office visit code (99211-99215). You will probably 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 1.03 relative

value units (RVUs), unadjusted for geography. That translates to about $38 for this visit.

Answer 2: Handling the Specimen Depends on Payer

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 the 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 795.0X for Abnormal Results

You should report 795.0x (Abnormal Papanicolaou smear of cervix and cervical HPV) if the ob-gyn repeats the Pap smear due to abnormal results. This code requires a fifth digit, points out Peggy Stilley, CPC-OGS,

ACS-OB, clinic manager at OU Physicians in Tulsa, Okla. If you don't include the fifth digit, 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 795.01 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 can use one of two

codes. Report V76.2 (Special screening for malignant neoplasms; cervix) or 795.08 (Unsatisfactory smear) if the first smear was inadequate, says Karen O-Malley, office manager of an ob-gyn practice in Arlington

Heights, Ill.

In the notes associated with 795.08, the ICD-9 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.