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Ob-Gyn Coding Alert

Reader Questions:

Confront Diagnostic Pap Smear And Medicare

Published on Sat Mar 08, 2008

Question: I know that Q0091 is for screening purposes.-I am trying to find actual documentation on the CMS Web site that states I should include a diagnostic pap in the E/M code and not bill Q0091 in that scenario. Where should I look? Alabama Subscriber Answer: Your carrier will deny Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) due to Correct Coding Initiative (CCI) edits. CCI bundles all E/M services into Q0091. The only way to bypass the edit is to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Using this modifier would mean the E/M is separate and significant from the collection (that is, the collection was for a screening pap smear while the E/M involved a problem that ob-gyn dealt with), which is not the case. The purpose of the visit is to evaluate a problem that requires the ob-gyn to collect a diagnostic Pap smear.
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