Ob-Gyn Coding Alert

Question: What is the best way to code for an office visit to repeat a Pap smear for a previous unsatisfactory smear? The sample came back as inadequate cells, not an abnormal Pap smear.

Massachusetts Subscriber

Answer: The answer will depend on the payer.

For Medicare and other carriers that recognize the HCPCS level-II Pap smear code, report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). Indicate a repeat Pap smear by attaching modifier 76 (Repeat procedure by same physician) to Q0091.

If this is a Medicare patient, your diagnosis will be V76.2 (Special screening for malignant neoplasms; cervix). You should also report either V76.47 (Special screening for malignant neoplasms; vagina) or V76.49 (Special screening for malignant neoplasms; other sites) because this is still a screening Pap smear. 

For other payers, the diagnosis code will be 795.08 (Unsatisfactory smear).

Whether you should also code an E/M service in addition to Q0091 depends on what the encounter entailed and whether the payer reimburses separately for the Pap smear collection. Although a visit for a repeat Pap smear may involve more than just the procedure, just as often, the ob-gyn performs no additional service. Your ob-gyn's documentation will tell you whether billing an E/M code in addition is appropriate.

Note: If you can report an E/M service, remember to add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if you are also billing Q0091 for the collection.

Remember: The diagnosis code on the E/M service will depend on the primary complaint. For instance, if you want to link a diagnosis code to counseling for the unsatisfactory Pap, you can appropriately use 795.08. If the E/M service dealt with other issues (such as vaginal itching), you should use the diagnosis code for the complaint.

If your carrier does not accept Q0091, you should only bill a low-level E/M service with the pap screening dx (795.08), and modifier 76 will not apply.

Caution: You should not report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) unless you physically deliver the specimen to the lab or the practice incurs a real cost in preparing the specimen (such as centrifuging). Also, the AMA CPT Assistant (winter 1994) clearly indicated that 99000 is not appropriate to report for the Pap smear specimen collection.
 
The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.