Ob-Gyn Coding Alert

Question: My ob-gyn performed a repeat Pap smear on a Medicare patient after the lab said that the sample was inadequate. How should I report this?

Nevada Subscriber Answer: You can report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) again for the second Pap smear. But you must append modifier 76 (Repeat procedure by same physician) to receive payment from Medicare.

Important: In this situation, the tricky part is choosing the diagnosis code to report to Medicare because that will impact the code service you get to report. Although you would use 795.08 (Unsatisfactory smear) for other payers, Medicare requires you to report V76.2 (Special screening for malignant neoplasms; cervix), V76.47 (... vagina) or V76.49 (... other sites) if the first Pap was a screening pap. You must use one of these three diagnosis codes to receive Medicare payment for the second screening Pap smear that your ob-gyn performs within the same year. If on the other hand, the ob-gyn did the first Pap for diagnostic purposes, then you-ll report the repeat Pap for insufficient cells to Medicare with a diagnosis of 795.08. Keep in mind, you will report an E/M service for the visit, not Q0091. And you-ll include the collection of the second diagnostic Pap in the E/M service.

Remember: Normally, Medicare will pay for only one screening Pap smear every two years for a low-risk patient and one every year for a high-risk patient. Attaching modifier 76 will tell Medicare to bypass the frequency edits and allow you to avoid a claim denial.