Medicare Specifies Code for Post-Hysterectomy Pap Smears
Published on Mon Oct 01, 2001
Medicare has refined coding for screening Pap smears for patients who have had a hysterectomy. Coders were in a quandary under the old rules because reimbursement for a screening Pap smear required either a high-risk or a cervical diagnosis code, even if the patient was without the risk factors and without a cervix. Medicare has added a third, noncervical diagnosis code that allows payment of screening Pap smears for women who have none of the high-risk factors and have had a hysterectomy.
Screening and Diagnostic Pap Smears
Medicare's coverage rules for Pap smears distinguish between diagnostic tests ordered for patients with signs and symptoms of disease and screening tests for asymptomatic patients. "The only way the laboratory knows if the Pap smear is a diagnostic or screening test is for the physician to identify it correctly," says Elizabeth Sheppard, HT (ASCP), manager of Anatomic Pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C. "That's why it is important for labs to educate physicians about these rules.
"Report diagnostic Pap smears with the appropriate CPT procedural code (88142-88154 or 88164-88167) based on the testing methodology," Sheppard says. However, coders should report screening Pap smears using the appropriate HCPCS code (P3000, G0123 or G0143-G0148). For both CPT and HCPCS test codes, choose the code that accurately describes the lab technique, reporting system and screening/rescreening method employed.
"Don't be confused by the codes' use of the terminology 'screening and rescreening,' " Sheppard warns. The description of a Pap smear's being "screened and rescreened" refers to the cytotechnologist's or automated system's observation of the slide to identify potentially abnormal cells and the possible rescreening by a pathologist. "This is different from Medicare's use of the term 'screening Pap smear,' which refers to conducting any of the testing methodologies in the absence of signs and symptoms of disease," Sheppard says.
Medicare Rules for Screening Pap Smears
"In order for Medicare to cover a screening Pap smear, certain rules regarding testing frequency and diagnosis coding must be met," Sheppard says. Medicare categorizes patients as "high-risk" or "low-risk," and coverage frequency varies accordingly. "If a screening Pap smear is ordered at a frequency greater than allowed by Medicare, labs must be sure to have an advance beneficiary notice (ABN) on file so they can bill the patient for the service," Sheppard says.
Medicare covers a screening Pap smear for high-risk women of childbearing age once a year. Patients at high risk for cervical cancer are those with any of the following histories: early onset of sexual activity, multiple sexual partners, history of sexually transmitted disease, [...]
