Ob-Gyn Coding Alert

In the ob/gyn setting, Pap smears rarely have to be repeated because of an insufficient number of cells on the first slide. But repeating a routine process like this raises several questions: Whose fault is it that the test has to be repeated, how should the repeat test be coded and who should absorb the cost of the subsequent visit? Does the patient pay for the repeat procedure, or is the cost of the second sample absorbed by the practice?

Coding the Sequence

If a Pap test needs to be repeated because there are too few cells collected to conduct the appropriate screenings, it usually is not due to a codeable medical condition or physician error. Very often, especially with postmenopausal women, the endocervical lining from which the cells are scraped has grown thin. If the lining has thinned to the point that the initial sampling does not capture enough cells, the laboratory cannot perform the required screenings of the cells, and a second Pap smear has to be taken.

Assuming that the first Pap smear was taken as part of a preventive medicine or annual well-woman exam, the initial visit would be coded using preventive medicine evaluation and management (E/M) codes for a new or established patient, most likely codes 99385-99387 (initial preventive medicine evaluation and management of an individual including a comprehensive history, a comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, new patient) depending on age, or 99395-99397 for an established patient, also depending on age.

For the well-woman visit, the diagnostic code would be V72.3 (gynecological examination), which includes taking the Pap smear specimen. This scenario also assumes that the physician or practice uses the services of an outside laboratory, rather than performing the Pap smear interpretation in house. The laboratory would bill for the cytopathology, or testing of the smears, using the 88141-88199 (cytopathology, cervical or vaginal ... ) group of codes, depending on the screening methods used.

If the laboratory is unable to complete the necessary screenings due to insufficient cells on the slide, they will notify the practice. The practice then will have the patient return for another Pap smear. For this repeat collection, an established patient E/M code would be used, most likely 99212 (office or other outpatient visit for the evaluation of an established patient ... including a problem focused history, a problem focused examination and straightforward medical decision-making). The repeat visit is coded at a level two because the more comprehensive history, examination and medical decision-making likely took place at the initial visit.

Diagnosis Coding for the Repeat Pap

When billing for the second office visit to collect the repeat Pap, practices will need [...]