Wiki Pap smear visit by PCP

[Feather]

We are a family practice and have been having issues with billing pap smear visits. The provider does a PE visit and has the patient return for a separate visit for the pap smear/breast exam- patient may be due for a pap but not a PE or vice versa. Previously we were billing the age appropriate preventative E&M code for both visits, but we were getting denials stating PE was already billed in the past 12 months. So now we are coding the pap appts with office outpatient E&M code (99213-99214) and the pap smear collection. Is this correct?

 

[mitchellde]

If you are performing a well woman then your dx code is the V72.31. Most carriers follow Medicare and you use the Q0091 and the G code for the pap and pelvic. You will not use the lab code for pap collection, there is no code for that activity. It is built into the visit. Do be aware that whoe the patient may be entitled to one preventive every year, not every carrier allows for a free well woman every year, so sometimes the denial is due to timing.

 

[driecam@yahoo.com]

I also bill for a PCP. When he performs a pap smear, WWE I bill it as V72.31. If no pap was performed, he still completes the physical exam portion with the exception of the pap smear, I bill it as a regular physical....V70.0

If the patient returns and he only performs the pap smear, I bill an E/M-low level because that's usually the only reason she is there and code as V76.2 for just pap smear test only.