Ob-Gyn Coding Alert

Find out whether you can report 99000 for handling of the specimen If your patient's Pap smear results return as abnormal or display insufficient cells, the ob-gyn will probably perform a repeat smear. Use proper E/M coding to get the payment you deserve.
Zoom In on Your Visit Code When the patient comes in for a second Pap smear, submit the appropriate E/M service. CPT does not include a code for taking the Pap, so you should use the office visit code (99211-99215), says Karen Green, CPC-H, OGS, coding specialist for Eau Claire Women's Care in Wisconsin. You will probably report 99212 for the Pap retest visit because the patient is here only for the Pap smear. That translates to almost $40 per visit, using the Medicare Physician Fee Schedule national rate. Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) carries 1.03 relative value units (1.03 RVUs x 2008 conversion factor 38.0870 = $39.23). Bill Collection Under These Criteria 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 under CPT rules, you should not report this handling code unless the office incurs an expense over and above normal costs (such as paying for someone to deliver the specimen or using office equipment to process the specimen before transportation), says Jan Rasmussen, CPC, ACS-OB, ACS-GI, owner of Professional Coding Solutions in Holcombe, Wis. 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. Isolate These ICD-9 Codes You should use 795.0x (Abnormal Papanicolaou smear of cervix and cervical HPV) as the diagnosis code if the ob-gyn repeats the Pap smear due to abnormal results. "This diagnosis code denotes a diagnostic Pap smear, not a screening Pap smear," Rasmussen says. Watch out: Code 795.0x requires a fifth digit, says Haydee Cruz, RMA, practice manager for an ob-gyn urogynecology practice in Lowell, Mass. Include this detail to avoid a truncated-code denial. Example: A 32-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 four months for a repeat [...]