Ob-Gyn Coding Alert

Question: Which CPT/ICD-9 codes should we use for a screening Pap smear for insurance carriers? Is Medicare the only insurance with a screening procedure code?


Illinois Subscriber

Answer: The collection of a screening Pap smear is only sometimes paid by insurance carriers other than Medicare (they require Q0091, Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). When these private payers reimburse directly for this collection, they will recognize this Q code as well.

For the ICD-9 codes, you have two options: either V72.31 (Routine gynecological exam) if it is done at the time of a routine exam, or V76.2 (Special screening for malignant neoplasms; cervix) if the purpose of the visit is only to take a Pap specimen.

The American College of Obstetricians and Gynecologists says you can bill for handling the specimen (99000, Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) but teaches that the collection is just part of the E/M service. Under no circumstances should you bill the collection using the lab codes for the interpretation of the Pap smear. A pathologist provides that service, not the ob-gyn.