Wiki Pap coding in a family practice

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jmeberst314@gmail.com

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Hello!

I work for a family practice and our office does PAP's, I have several questions so I do apologize in advance for the long thread.

1. Our patients book their annual physicals separate from their pap smears, is there a way to code (CPT & ICD) so that both of these annual physicals get paid for? I've just been using the preventive medicine visits w/the appropriate V codes.
2. When the pt comes in for a straight forward pap is there a code like Q0091 that I should be coding w/these visits, if so what dx code?
3. When a patient has to return to the office due to abnormal pap results how should I code this, both the CPT and ICD, please.
4. If the patient has her own OBGYN and gets her pap there then comes to our office to have her annual physical how do I code this so that I get is paid at 100%?

Thank you for your help, I really appreciate it.

Jessica
 
Pap

Couple of things:
Make sure that the insurance carrier will accept two well visits from you per year even with different dx.
The Q0091 is for taking the specimen. This is an instruction from Medicare to use this code. NOt necessarily is accepted by all insurances.
When the patient comes to discuss the abnormal results you code the appropriate CPT level and the abnormal PAP code according to results.
If they have Medicare and they already went to see their GYN for the bi-annual PAP (or annual if they are high risk) they should be aware and do not make unnecessary services and they should sign an ABN to say they will become responsible for payment if denied by frequency.
Hope this helps,
CC
 
When billing for an annual physical exam. Use the age appropriate Preventive Medicine CPT code, with ICD-9 code V70.0. If you are also checking for cancer screening, as in a pap smear, I would suggest if you are doing this at the same visit, bill an E/M visit with modifier 25 and use V72.31, but if this is for birth control purposes, I would use the appropriate V code for birth control, I would use V65.49 "other specified counseling".
If a patient comes to your office for abnormal pap from another office. I would bill and E/M for this. I would code what the abnormality is, since they are probably seeking treatment.
If a patient goes to her own OBGYN and has her pap there, and comes to your office for an annual, make sure you get an ABN on all physicals and paps, and bill the correct preventive management code along with V70.0. If the insurance does not pay, it may be due to the OBGYN office not billing correctly or they may not cover Annual Physicals. Hope this helps.
 
Also you could bill if the patient comes in regarding birth control, IUD placements, counseling regarding these, look in the V25 ranges in the ICD-9 book.
 
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