Ob-Gyn Coding Alert

Question: Our OB/GYN group is under new management, and our new manager is insisting I can and should be billing 99000 with all our screening and diagnostic pap smears. However, I feel this is incorrect.

We have a satellite laboratory for the hospital right here in our office building and we just put the Paps aside for the pathology lab in the main hospital. It's the main hospital that supplies the courier to come and pick up the specimens daily. I don't feel our physicians incur any "above and beyond" expense to handle these Paps. It's the hospital that is sending the courier and billing for it. Am I correct in thinking that 99000 is only if there is an extra expense involved with handling Paps? If so, can anyone help me approach the new manager without making any waves? Is there an actual site that I can print off to back this up? I am billing Q0091 with our Medicare screening Paps.

Texas Subscriber

Answer: Medicare pays for collection and handling (Q0091, Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) because they had, in the past, not paid for the visit. That has changed somewhat in recent years, but they kept the benefit for the Pap smear.

In addition, Medicare will not pay for collection of the Pap when it is done for diagnostic purposes and include that collection as part of the billed E/M service. Both CPT® and the American Congress of Obstetricians and Gynecologists (ACOG) have published that you should include the collection of the Pap specimen in the visit at which the physician collected it. 

Handling (99000, Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory), however, is another matter, and it may or may not be paid by insurance. Almost all include it and will deny the line item (hence raising your AR and write-offs). 

According to CPT®, code 99000 is for over and above costs such as having to use office equipment to process the sample before sending it to the lab.

Watch out: Labeling the specimen or filling out the lab slip would be your cost of doing business and included in overhead costs for the practice (that is, an incidental service). This cost is accounted for in every RVU established for every E/M service.

The tide is against your practice in collecting anything for 99000, but if the manager insists, you should do so. Then, you should collect data about how much "money" you are accruing along with the costs of billing and perhaps appealing. CIGNA, for instance, states "Specimen Handling / Conveyance - The handling or conveyance of a specimen from a physician's office to a laboratory (CPT® 99000) is not separately reimbursable."