Ob-Gyn Coding Alert

Be wary of Q0091, G0101 -- they generally won't apply

Warning: The rules for coding standard Paps aren't the same for Medicare patients who underwent a hysterectomy due to malignancy.
 
Avoid botching up your post-hysterectomy claims by following our experts- coding advice for handling these tricky situations. How to Handle Post-Hysterectomy Pap Claims Problem: When a Medicare patient returns after a hysterectomy (for a malignant condition) for follow-up vaginal Pap smears in your office, should you report 99212 or 99213, or should you just report Q0091?

Watch out: First of all, you should not report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), because this code refers to collection of a screening Pap smear.

After a hysterectomy that the ob-gyn performed to treat cancer, all of the Paps will be diagnostic, not screening. Therefore, you should report the Paps with an E/M code (for example, 99213, Office or outpatient visit for the evaluation and management of an established patient ...), but payers now include the collection in the E/M service. Confront the Years-Afterward-Pap-Smear Question Problem: But what if the ob-gyn conducts the Pap smear six years after the hysterectomy? Could you submit Q0091?

-The Pap code (Q0091) remains the same,- says Cheryl A. Lewis, CPC, billing manager for ZIA Ob-Gyn Ltd. in Yuma, Ariz. If the purpose of the E/M visit is to follow up for the patient's cancer, then the Pap smear is diagnostic, coding experts say.  

If the ob-gyn wishes to put the patient back into the screening group, then she reverts to one Pap smear every two years instead of one each year, under Medicare rules, because the Medicare criteria list for screening each year does not include a history of cancer (for example, V10.42, Personal history of malignant neoplasm; other parts of uterus).

If your physician thinks the patient requires a yearly Pap smear, considering her history, it will have to be a diagnostic service with the collection of the specimen included in the E/M code.

G Code Refers Only to Screening Similarly, G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) involves a screening exam, not a diagnostic exam. Therefore, as long as the ob-gyn doesn't use the cervical or vaginal exam to check for cancer for the post-hysterectomy Medicare patient, you can report G0101.

Keep in mind: For Medicare patients, you have to have 7 of the 11 exam elements for a pelvic exam (G0101). If your ob-gyn is dealing with a post-hysterectomy patient, then he can state, -the uterus, cervix and ovaries are surgically absent,- and that counts, says Jenny Baker, CPC, professional services coder of Women's Health at Oregon Health and Sciences University in Portland.

On the other [...]