Primary Care Coding Alert

When tests, exams or procedures need to be repeated, family practice coders are often concerned that claims may be summarily rejected. Most carriers use frequency edits to alert physicians that they will allow certain types of services only at specified intervals.

Such is the case with Pap smears. Medicare, for instance, reimburses for screening Pap smears only once every three years unless the patient is categorized as high risk or has a personal history of an abnormality. If that is the case, annual Pap smears are then allowed.

But many coders wonder how to report Pap smears that are done even more frequently, specifically when a screening study exhibits abnormal results and is repeated several times within a few months. The answer is straightforward, according to Melanie Witt, RN, CPC, MA, an independent consultant specializing in coding and documentation education based in Fredericksburg, Va., and former program manager for the department of coding nomenclature at the American College of Obstetrics and Gynecology (ACOG).

There is a simple rule of thumb, she explains. Coders should remember to code only what they know at the time of each visit when the Pap smear is collected.

Step 1: Coding the Original Screening Pap Smear

Coding the initial Pap smear correctly depends on a number of factors. If the specimen is collected during an annual preventive care visit, coders should choose the appropriate code from the 99395-99397 (established patient) or 99385-99387 (new patient) series. Coders have three diagnostic linkage possibilities to choose from:

V72.3 (gynecological examination) when the patient has a cervix;

V72.3 plus V76.47 (special screening for malignant neoplasms; vagina) plus V45.77 (acquired absence of uterus) when the patients uterus and cervix have been removed for a non-malignant condition; or

V67.01 (follow-up vaginal pap smear) plus V45.77 plus V10.14-V10.44 (personal history of malignant neoplasm, genital organs) when the uterus and cervix have been removed due to cancer.

If the screening Pap smear is collected during an office or outpatient visit for a specific problem, coders would select from 99212-99215 (established patient) or 99201-99205 (new patient). In either instance, V76.2 (special screening for malignant neoplasms; cervix, routine Papanicolaou smear) or V76.47 would be assigned in addition to the problem encountered unless the purpose of the visit was for follow-up to cancer. In that case, the correct additional code would be V67.01.

Some practices may also have qualified under the Clinical Laboratories Improvement Act (CLIA) regulations to perform the Pap smear interpretation. In this case, they would also report the appropriate lab codes (88141-88155, 88164-88167) linked to a diagnosis that supports why the test was ordered.

Code Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to [...]