Ob-Gyn Coding Alert

One of the most common procedures performed in the gynecologists offices is the collection of a screening Papanicolaou smear. According to the National Cervical Cancer Coalition, All women who are or have been sexually active, or have reached age 18, should have Pap tests and physical exams regularly. Because of the strong connection between cancer prevention and Pap smears, assuring patients are tested is a high priority for ob/gyn practices. But coding for Pap smears is full of confusion.

Physicians, nurses and billing staff often think they should be able to bill one of the many cytopathology smear codes starting with 88141, says Deb Lief, CPC, president of the North Texas Chapter of the American Academy of Professional Coders and manager of coding compliance for ProMedCo, a practice management firm in Fort Worth, TX. Encounter forms often have several of these codes listed for the provider to check off, and they think they will get paid separately for performing a the test. But Pap smear collection is part of the well-woman exam -- a component of the comprehensive procedure. And this is a big educational issue for the staff, Lief explains. This article examines the various complexities of coding for Pap smears by considering the various situations that may effect your reimbursement.

Annual Well-Woman Check

Many Pap smears will be performed when the woman presents for her annual well-woman check-up. The patient has no other problem, and the physician simply does a Pap smear as part of the comprehensive preventive medicine examination. This service includes obtaining the Pap and making the slide. It should be billed using one of the preventive medicine codes (99384-99387 for new patients or 99394-99397 for established patients). Whether a patients insurance covers preventive services will depend on the policy and payer.

Dont feel badly about billing your patient for their well-woman exam if their insurance does not cover it, Lief says. Most insurance companies have non-covered services and the patients voluntarily enter into a contract with the company. Youre providing a potentially lifesaving procedure, so dont apologize. Have them pay before they leave the office.

When Pap Smear is Attached to Problem Visit

The results of a new Gallup survey of womens attitudes, knowledge and behavior regarding Pap smears, commissioned by the College of American Pathologists, points out that nearly 40 percent of American women risked their lives by not having a Pap smear in the last year. The most cited reason was a lack of time. The result of this fact is that gynecologists often find themselves performing Pap smears when patients are [...]