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Ob-Gyn Coding Alert

Test Your Pap Smear Skills

Published on Mon Sep 27, 2004

Compare your answers to the correct responses

 1. A low-risk non-Medicare patient returns to the ob-gyn upon receiving a finding of atypical squamous cells of undetermined significance (ASC-US) after her last visit. The ob-gyn performs another Pap smear.

Answer: C
 
Pap smear collection is usually included in the E/M service. Your ob-gyn may be tempted to report the test separately (using 88141, for example), but don't fall into that trap. Ob-gyns aren't usually the provider who screens the smear - a lab does. Therefore, the lab would charge for the screening, not the ob-gyn.

 2. A low-risk Medicare patient arrives at your office and undergoes an annual Pap smear and pelvic and breast exam. How should you code this scenario?

Answer: E
 
Watch out. This is a trick question. Medicare does not pay for an annual Pap smear for low-risk patients.
 
"Medicare is tricky. You have to make sure you are careful with the coding and fully explain to patients what is and is not covered," says Michelle King, billing manager at Baystate Ob-gyn Group Inc. in Springfield, Mass.
 
High-risk: However, Medicare will pay for annual exams for high-risk patients. If the patient qualifies, you would report Q0091 for the breast and pelvic exam and G0101 for the Pap smear. Be sure to report V15.89 (Other specified personal history presenting hazards to health; other) in addition to a secondary code such as:

 

  • History of HIV (V08 or 042)
     
  • History of sexually transmitted diseases (V13.8)
     
  • Five or more sexual partners in her lifetime (V69.2)
     
  • Onset of sexual activity before 16 years of age (V69.2)
     
  • Diethylstilbestrol (DES) exposure (760.76)
     
  • History of no Pap smears in the last seven years (V15.89)
     
  • Absence of three consecutive negative Pap results (V72.32) 
     
  • Any gynecological problem (such as cervical or vaginal cancer or genitourinary system problem) in the last three years if the patient is of childbearing age.
     
    Low-risk: For a low-risk patient who has not been seen in 24 months, you should report V76.2 (Special screening for malignant neoplasms; cervix) as the diagnosis code.

     3. Even though the non-Medicare patient does not complain of any problem, the ob-gyn performs a Pap smear as part of a well-woman examination.
     
    Answer: D
     
    In this circumstance, you should report one of the preventive medicine codes. Use 9938x or 9939x depending on age, says Lisa Leach, CCS-P, coding specialist at West Texas Medical Associates in San Angelo. These codes include the reimbursement for the Pap smear collection.
     
    Note: A few carriers may also reimburse for specimen handling, although that may be a minor amount. If so, you can use 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

     4. A patient who has not had a Pap smear in three years presents complaining of stress urinary incontinence. The ob-gyn performs a pelvic exam and Pap smear.

    Answer: C and D
     
    Another trick question.
     
    First of all, you should include the Pap smear collection and slide preparation in the E/M code (such as 9921x for established patients). Include the diagnosis of 788.3x (Urinary incontinence), depending on the type, King says.
     
    In addition, "You can also report 9939x with a diagnosis of V72.3x (Gynecological examination), 99000 for the specimen handling charge, and any applicable labs such as urine, hemoglobin, and so on," King says.
     
    Heads-up: Remember 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 the E/M code, which is separate and significant from the preventive service.
     
    Note: With proper documentation, you can ethically raise the office visit to a higher level based on the amount of medical decision-making or an additional examination, when the ob-gyn performs such services.

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