Primary Care Coding Alert

Question: Should I report an office visit in addition to a repeat Pap smear?

Massachusetts Subscriber

Answer: Whether you should code an E/M service in addition to the collection of another Pap smear specimen depends on what the encounter entailed. A visit for a repeat Pap smear may involve more than just the procedure. If the FP provides a significant, separately identifiable E/M service, you can appropriately bill an E/M code.
 
In this case, you should report the office visit, such as 99211-99215 (Office or other outpatient visit for an established patient -). To indicate that the service is significant and separate from the Pap smear collection, Medicare requires you to append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M service. You should link the appropriate E/M code with modifier 25 to 795.08 (Unsatisfactory Pap smear).
 
But if the patient returns for a -re-Pap- due to an unsatisfactory smear, and the physician performs no additional service, you should not report the office visit. Instead, charge only the collection. For Medicare and other carriers that recognize the HCPCS level-II Pap smear code, report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). Code a re-Pap by attaching modifier 76 (Repeat procedure by same physician) to Q0091.
 
Report Q0091-76 with one of three V codes: V76.2 (Special screening for malignant neoplasms; cervix), V76.47 (Special screening for malignant neoplasms; vagina), or V76.49 (Special screening for malignant neoplasms; other sites.)

 -- Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.