Ob-Gyn Coding Alert

Question: We perform Pap smears here, but then lab them out. We don't charge for them; the lab does. Should we start charging the G and Q codes for Medicare patients?


Delaware Subscriber


Answer: Absolutely. Medicare reimburses this service once every two years for a low-risk patient and once per year for a high-risk patient. Go on the Internet to http://www.cms.hhs.gov/manuals/14_car/3b4600.asp to download the instructions on coverage criteria and which procedure and diagnosis codes to use.

Alternative: Some of the non-Medicare payers will also accept Q0091 (Screening Pap smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for Pap smear handling (rather than the more common 99000, Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

The information, which is in the Part B Carriers Manual, Section 4603, stipulates the coding rules prior to July 1, 2001, and after this date. That's when Medicare changed the frequency for the low-risk patient from every three years to every two years and when the diagnostic linkages changed from just V76.2 (Special screening for malignant neoplasms; cervix) to either V76.2, V76.47 (Special screening for malignant neoplasms; vagina) or V76.49 (Special screening for malignant neoplasms; other sites).