pap
Pap smears are included in E&M unless they are screening Q0091 which is used for medicare.
Q0091 screening pap smears
Attention: Practicing ACOG Fellows and Junior Fellows
ACOG has recently received notice from several members that some private payers are demanding repayment of monies paid out for a screening pap smear collection using the HCPCS Q0091 code.
ACOG's position on reporting to private payers the collection of the screening pap smear is that the collection of a pap smear specimen is always part of the E/M or preventive medicine service and should never be reported separately.
ACOG's advice to members remains the same: practices should not bill the Q0091 code to private payers for screening pap smear collection. Q0091 is a code developed by Medicare for services provided to Medicare patients. Medicare does not reimburse for preventive services, such as those reported with CPT-4 codes 99384 - 99397. However, it does allow payment of Q0091 as an exception to its general rule.
Similarly, collection of a diagnostic pap smear for a Medicare patient (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service and is not reported or reimbursed separately.
Some private payers do reimburse for the Q0091 code. In such cases, ACOG strongly recommends obtaining the guidelines for that specific policy in writing.
If a payer demands repayment of reimbursement relative to the Q0091 code, ACOG recommends that you contact legal counsel. State laws and regulations vary as to the time limits for the payment recovery period. However, when the recovery efforts are based on suspicion of fraud or misconduct on the part of the practitioner, there is no time limit for recovery.
Susan Eosso, CPC,CMRS