Ob-Gyn Coding Alert

Question: My office did a repeat Pap smear for a previous insufficient specimen, and Cigna reimbursed the service only $8. I called the rep, and he said I needed to use a modifier. Cigna covers $8 for Q0091 but nothing for the office visit, because the rep said the E/M was integral to a more complex primary procedure. What should I do? North Carolina Subscriber Answer: You probably need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to your E/M code (such as 99201-99215, Office or other outpatient visit ...). You should link the E/M code with modifier 25 to 795.08 (Unsatisfactory cervical cytology smear). Payment, however, isn't a sure thing. Your carrier might consider the Pap collection as included in the E/M service. In other words, if the patient returns for a [...]