Oncology & Hematology Coding Alert

Question: Our physician performed a Pap smear and sent it for histopathological examination. The pathology lab however reported inadequate specimen. The physician then repeated the Pap smear on the same patient. How can we report this repeat service?

New Mexico Subscriber

Answer: For the repeat Pap smear described, you can report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), and you must append modifier 76 (Repeat procedure by same physician). This modifier will help you earn for the repeat procedure. (Medicare Claims Processing Manual, Chapter 18, Section 30.5.E. 

However, when you have this situation, if done for screening purposes, you would again report the screening ICD-9-CM V codes: V76.2 (Special screening for malignant neoplasms, cervix), V76.47 (Special screening for malignant neoplasms, vagina), or V76.49 (Special screen for malignant neoplasms, other sites) and report 795.08 (Unsatisfactory cervical cytology smear) to explain to the carrier the need for the additional cytopathology test.

The corresponding ICD-10-CM codes for V76.2 and V76.47 are Z12.4 (Encounter for screening for malignant neoplasm of cervix) and Z12.72 (Encounter for screening for malignant neoplasm of vagina), respectively. The code V76.49 maps to the following ICD-10-CM codes:

• Z12.89, Encounter for screening for malignant neoplasm of other sites

• Z12.0, Encounter for screening for malignant neoplasm of stomach

• Z12.79, Encounter for screening for malignant neoplasm of other genitourinary organs

For additional information regarding Pap smear reporting and other preventive services, see refer to the following link for a handy chart developed by CMS: http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf.