Primary Care Coding Alert

Question: How should we bill Medicare for obtaining a diagnostic Pap smear? The patient has postmenopausal bleeding and is not in a high-risk category. I'm concerned that Q0091 is not appropriate because the code definition explicitly says "screening."

North Dakota Subscriber

Answer: You are correct. Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is assigned only for a screening study. In this instance, you would report only the office visit code that reflects the level of E/M service provided, i.e., 99201-99205, office or other outpatient visit, new patient; and 99211-99215, office or other outpatient, established patient.
 
CPT provides a code for diagnostic Pap smears, 88150 (cytopathology, slides, cervical or vaginal; manual screening under physician supervision), which coders might be tempted to assign. This code should not be used, because  it includes cytopathological examination of the smear, a service usually provided by a pathologist, not the family physician.

   
Answers to Reader Questions and You Be the Coder were reviewed by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; and Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians.