Primary Care Coding Alert

Question: Medicare denied our claim using Q0091 and diagnosis 616.0 for Pap smear collection, stating that the codes and procedure are not consistent with each other. What procedure code should we use for obtaining a Pap smear?

Answer: Medicare accepts Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for a routine Pap smear collection for screening purposes. Because of that, your problem probably lies with your diagnosis code.

Diagnosis 616.0 (Inflammatory disease of cervix, vagina, and vulva; cervicitis and endocervicitis) represents a very specific diagnosis. A Pap smear collected in conjunction with this diagnosis would probably be diagnostic, not screening.

For Q0091, you'll want a routine diagnosis code paired with the routine Pap collection code. A better choice is V76.2 (Special screening for malignant neoplasma; cervix).

Add-on: Q0091 may be reported in addition to an E/M service when the E/M service is separately identifiable. Therefore, remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code (such as 99201-99205 for a new patient office visit or 99212-99215 for an established patient office visit) when reporting an E/M code with Q0091.