Ob-Gyn Coding Alert

Question: Wondering if someone could give guidance when it comes to patients who have their annual physical with a male physician but prefer to have a female do the Pap/breast exam on a different day. Should we bill the Q0091 for the Pap smear on the second visit, or could we do a 99212?

Georgia Subscriber

Answer: First and foremost, there should be some patient education going on here. Normally, insurance is going to pay for one preventive exam a year, and this can be done by the female physician, which will include what is medically indicated for her age group.

In the event these two providers are not affiliated, you can bill the 99391-99397 (Established patient preventive medicine services) code twice and hope for the best.

You can only use code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for a Medicare patient. Normally, commercial insurance will not recognize this code.

Code 99212 (Office or other outpatient visit …) might fly if the pelvic and Pap smear is all the female ob-gyn did, but you will also have to include the Z01.411 (Encounter for gynecological examination (general) (routine) with abnormal findings) or Z01.419 (Encounter for gynecological examination (general) (routine) without abnormal findings) code to identify that the visit was for a gyn exam only which might lead to a denial.