Ob-Gyn Coding Alert

Question: When a patient between 18 and 64 years of age comes in for a routine examination and Pap smear, what is the correct way to bill for a thin-prep smear that we send out for pathology? I thought we should use 88142 for collecting the smear.

New Mexico Subscriber

Answer: When you report 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision), you are telling the payer that your physician personally interpreted the Pap smear slide and that you have the appropriate Clinical Laboratory Improvement Act (CLIA) certificate to perform this level of slide interpretation. This is highly unlikely if you are an ob-gyn practice and, in your case, you stated that you send the smear out for pathology interpretation.

If payers that reimburse you when you use this code perform an audit, you will have to refund these payments. If you bill for the test interpretation on behalf of an outside lab -- and the lab does not bill for the test -- you can append modifier -90 (Reference [outside] laboratory) to the test code to inform the payer that this is the situation.

That said, collecting the Pap smear specimen is considered included in the visit during which the ob-gyn collected it, according to the American College of Obstetricians and Gynecologists. Some payers will reimburse a small handling fee when you submit 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory), but many others will not.

Medicare allows physicians to collect a fee for the Pap specimen handling when the physician collects it during an otherwise noncovered service and the Pap collection is for screening rather than diagnostic purposes. The code to use for Medicare in this situation is Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). And some private payers accept this code instead of 99000, so you should always check with your carriers to determine which code they prefer if they are willing to reimburse separately for the specimen collection and handling.