Oncology & Hematology Coding Alert

Question: We obtain pap smears in our office and they are sent to a reference lab for reading. I have come across several procedure codes for pap smears (Q0091, G0101, P3001, 88142, 88164), and I'm not sure of which to use. Also, some of our patients, once diagnosed, return every three months for a pap smear. How should we bill for them?

Louisiana Subscriber

Answer: If you perform the pelvic and cervical examination and prepare the pap smears for the laboratory, you cannot bill the pathology CPT codes. The pathology codes for pap smears, 88141-88155 and 88164-88167, are used to report cervical or vaginal screening and physician interpretation of services. These codes are billable by the lab reviewing and interpreting the slides.
 
HCPCS codes P3000 (screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision) and P3001 ( requiring interpretation by physician) are temporary Medicare pathology codes, which are also not billable by the oncology practice unless you have your own laboratory.
 
HCPCS Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is appropriate for your office to bill in addition to an appropriate E/M code when a separately identifiable E/M service is provided. However, Q codes fall under the jurisdiction of your local carrier. You should check the payment policies of your intermediary. If this code is not recognized by your local carrier, the only procedure that is billable is the appropriate E/M service.