Ob-Gyn Coding Alert

Question: On page 30 in the “Validate This Repeat Pap Plus UTI Scenario” (Ob-Gyn Coding Alert issue April 2016, Vol. 19, No 4), you answered that the diagnosis for the repeat Pap smear should be Z12.4. I am wondering why it wouldn’t be R87.615?

Ohio Subscriber

Answer: This scenario was for a Medicare patient, and Medicare will not accept a diagnosis of R87.615 (Unsatisfactory cytologic smear of cervix, for a screening Pap smear). If the physician had decided to repeat the Pap due to an abnormal result (and insufficient cells is not an abnormal result), he would code the visit as a problem E/M service (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

You would not bill Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for the collection. For all diagnostic Paps, the collection is part of the visit. 

Therefore, their instruction via a transmittal more than 11 years ago was to report a screening diagnosis Z12.4 (Encounter for screening for malignant neoplasm of cervix) with Q0091, and add a modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to this code to indicate it was a repeat (for insufficient cells). Code Z12.4 is the matching code for the ICD-9 V code listed in the original transmittal for just a screening Pap smear.

The CMS transmittal was as follows:

Transmittal 440 Date: JANUARY 21, 2005
Change Request 3659

SUBJECT: Updating the Common Working File Editing for Pap Smear (Q0091) and Adding a New Low Risk Diagnosis Code (V72.31) for Pap Smear and Pelvic Examination

In those situations where unsatisfactory screening Pap smear specimens have been collected and conveyed to clinical labs which are unable to interpret the test results, another specimen is needed. When the physician bills for this reconveyance, the physician shall annotate the claim with Q0091 along with modifier -76 (repeat procedure by same physician). The use of this modifier will bypass the frequency editing in CWF for reconveyance billing (for a screening Pap smear).