Ob-Gyn Coding Alert

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The wrong diagnosis code could cost you $38 per patient

If your patient's Pap smear results return as abnormal or display insufficient cells, the ob-gyn likely will perform a repeat smear. Use proper E/M coding to get the payment you deserve.
 
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.

When the patient comes in for a second Pap smear, submit the appropriate E/M office visit code (99211-99215). You probably will be able to report a 99212 for this visit because the patient likely will come in only for the Pap smear. But CPT does not include a code for taking the Pap, so you should use the office visit code. For example, 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) carries 1.03 relative value units (RVUs), unadjusted for geography. That translates to about $38 for this visit.

Private payer versus Medicare: 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.

ICD-9 Codes Provide the Reason

You should use 795.0x (Nonspecific abnormal Papanicolaou smear of cervix) as the diagnosis code if the ob-gyn repeats the Pap smear due to abnormal results. This code requires a fifth digit, points out Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa. 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 ASCUS favoring benign and the physician asks her to come back in four 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.

How to code for inadequate samples: 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 should use V76.2 (Special screening for malignant neoplasms; cervix). For example the ob-gyn misses the cervical opening when taking a Pap smear because the patient is obese. The Pap result indicates the absence of endocervical cells and the physician likely would require another Pap. In this case you would submit the second Pap screening with V76.2.

Alternatively you can use 795.09 (Other nonspecific abnormal Papanicolaou smear of cervix) if the first smear was inadequate Stilley says. In the notes associated with 795.09 the ICD-9 manual indicates that you can use this code for "unsatisfactory smear."

"If the Pap smear returns as unsatisfactory the physician may have the patient return within three months for a report " says Brenda Dombkowski CPC a coding specialist at Obstetric-Gynecology & Infertility Group in Cheshire Conn. In this case "report an E/M depending on the services performed that day and the ICD-9 code would be 795.09."

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