Ob-Gyn Coding Alert

Learn the 2 key concepts of well-woman exams A physician routinely performs Papanicolaou, or -Pap,- smears for female vaginal and cervical screening during annual well-woman visits, but the doctor may also do them for diagnostic reasons. The procedure entails collecting a cell sample from the vagina or cervix and spreading it on a glass slide or transporting it to the lab in a preservative fluid.

For Medicare patients at low risk, you can report a Pap smear only once every two years. The diagnoses your physician can use when billing include the following:

- V72.31 -- Routine gynecological examination

- V76.2 -- Special screening for malignant neoplasm, cervix

- V76.47 -- Special screening for malignant neoplasm, vagina

- V76.49 -- Special screening for malignant neoplasm, other sites. Use V76.49 for women without a cervix.

If the patient is high-risk, you can bill the Pap smears annually. To classify a patient as high-risk, use (V15.89, Other specified personal history presenting hazards to health; other).

Your physician should supply a secondary diagnosis to explain why the patient is high-risk. The diagnoses include:

- History of HIV (V08 or 042)

- History of sexually transmitted diseases (V13.8)

- Five or more sexual partners (V69.2)

- Began sexual activity before 16 years of age (V69.2)

- Diethylstilbestrol (DES) exposure (760.76)

- Seven years without a Pap smear (V15.89)

- Absence of three consecutive negative Pap results (795.0x)

- Any gynecological problem (such as cervical or vaginal cancer or genitourinary system problem) in the last three years if the patient is of childbearing age. Make sure to use the appropriate HCPCS procedure code that corresponds to the type of test the physician performs.

Billable codes paid under the Medicare Physician Fee Schedule include:

- Q0091 -- Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory.

- P3000 -- Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision

- P3001 -- Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician

- G0101 -- Cervical or vaginal cancer screening; pelvic and clinical breast examination

- G0123 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision

- G0124 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by requiring interpretation by physician

- G0141 -- Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician

- G0143 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision

- G0145 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision

- G0147 - Screening cytopathology [...]