Ok, this may be a dumb question but I tend to be a literal person and in this case, the literature is a little confusing to me! What does Medicare consider High Risk for vaginal ca screening? Our carrier (NHIC) lists the high risk elements like this for the G0101:
The factors for women who are considered high-risk and are of childbearing age, who have had an examination that indicated the presence of cervical or vaginal cancer or other abnormality during any of the preceding two years are:
Cervical Cancer High Risk Factors
o Early onset of sexual activity (under 16 years of age)
o Multiple sexual partners (five or more in a lifetime)
o History of a sexually transmitted disease (including HIV infection)
o Fewer than three negative or any Pap smears within the previous 7 years
Vaginal Cancer High Risk Factors
o DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy.
Does this mean if a patient no longer has a cervix, they're only considered high risk if they've been exposed to DES? The cervical and vaginal cancer high risk factors are NOT separated out under their section for screening paps:
The patient is at high risk of developing cervical or vaginal cancer and at least 11 months
have passed following the month that the last covered screening pap smear was performed.
The high risk factors for cervical and vaginal cancer are:
1) Early onset of sexual activity (under 16 years of age)
2) Multiple sexual partners (5 or more in a lifetime)
3) History of a sexually transmitted disease (including HIV infection)
4) Fewer than three negative or any Pap smears within the previous 7 years
5) DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy.
Am I ok to bill for both the G0101 & Q0091 as high risk if the pt has a history of HPV? Help!
Thanks,
Sue
The factors for women who are considered high-risk and are of childbearing age, who have had an examination that indicated the presence of cervical or vaginal cancer or other abnormality during any of the preceding two years are:
Cervical Cancer High Risk Factors
o Early onset of sexual activity (under 16 years of age)
o Multiple sexual partners (five or more in a lifetime)
o History of a sexually transmitted disease (including HIV infection)
o Fewer than three negative or any Pap smears within the previous 7 years
Vaginal Cancer High Risk Factors
o DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy.
Does this mean if a patient no longer has a cervix, they're only considered high risk if they've been exposed to DES? The cervical and vaginal cancer high risk factors are NOT separated out under their section for screening paps:
The patient is at high risk of developing cervical or vaginal cancer and at least 11 months
have passed following the month that the last covered screening pap smear was performed.
The high risk factors for cervical and vaginal cancer are:
1) Early onset of sexual activity (under 16 years of age)
2) Multiple sexual partners (5 or more in a lifetime)
3) History of a sexually transmitted disease (including HIV infection)
4) Fewer than three negative or any Pap smears within the previous 7 years
5) DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy.
Am I ok to bill for both the G0101 & Q0091 as high risk if the pt has a history of HPV? Help!
Thanks,
Sue