Ob-Gyn Coding Alert

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.

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).

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.

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 Pap to follow any abnormal cell progress.

When the patient returns, you should code the appropriate office visit with 795.01 because the Pap is repeated due to abnormal cells.

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), coding will depend on the payer.

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 would usually recommend the patient have another Pap. For the Medicare patient, you would have to report V76.2 (Special screening for malignant neoplasms; cervix) for the second smear. You should also report collecting it with Q0091 with modifier 76 (Repeat procedure or service by same physician) added for clarification.

Alternatively, for commercial payers, you can use 795.08 (Unsatisfactory smear) if the first smear was inadequate, but report an E/M (99211-99215) depending on the services performed that day.