Ob-Gyn Coding Alert

Question: Which CPT code should I use to report a pelvic exam, or is it included in the office visit? Should we bill private insurers for Q0091?

California Subscriber

Answer: Code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is a Medicare code developed specifically for its program to bill for the collection of the Pap smear specimen that was part of an otherwise noncovered preventive service. Although some payers accept this code, most will not.

The collection is part of the examination, and you should not code it separately, according to the American College of Obstetricians and Gynecologists (ACOG). On the other hand, the organization goes on to state that some payers will reimburse separately for handling costs when you report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

Generally, the pelvic exam is always part of either the preventive service (99381-99397) or a problem-oriented E/M service (99201-99215 for outpatients or 99221-99233 for inpatients) if the ob-gyn performs one. The standard for coding an annual pelvic examination is to use the preventive medicine codes that represent the patient's age (for example, 99395, Periodic comprehensive preventive medicine reevaluation and management of an established patient; 18-39 years).