Wiki Pap smears

[cscrog01]

Hi All,

I have a question about a patient that follows-up for a routine pap smear due to insufficient cells on her previous visit. Is there a code for this or how should we bill for the return visit? Is it considered a no charge visit?

Also if a patient is not due for a pap smear but comes in requesting a pap only because a friend of hers was recently diagnosed with cancer and the patient herself has a history of abnormal paps, how would we bill that? The provider attempted to bill this as a 17 minute counseling session (99213) because the majority of the time was spent in counseling with the patient. Would this be something the patient has to just pay out of pocket for? The provider attempted to bill as 99213 with a V72.31, but that rejected. Could he bill a history of abnormal pap code?

Thank you!

 

[smidge1]

In answer to your first question, you would charge the pap visit with the V72.31 and the appropriate pap code you use. Physician should have it noted in progress note why repeated. Depending on your office procedures, you may no charge the 1st pap smear as they were unable to perform it. In our office we wait for paps to come back to be sure we have a valid charge and to add the additional testing performed if needed.

2nd question:If the pt. comes in asking to have a pap done and pt has a history of abnormal paps then yes, they should be charged as usual with progress notes specically stating the reason for test. I would say an E/M of maybe 99212 should be charged for the visit and use Hx of abnormal pap smear code to justify the visit also. It is mostly up to the physician to justify in notes and coding to get it paid.

I also found this online:

Screening Pap smears are done in the absence of sign, symptoms or history. They may fall into two risk categories: no-risk and high-risk. A no risk patient is eligible for routine screening once every two years (Medicare) or every year (other payers). A Medicare high-risk patient may receive a Pap smear on an annual basis.

High-risk factors include:

Early onset of sexual activity
Multiple sex partners
History of sexually transmitted disease
< 3 negative Pap Smears in 7 years
DES exposure during pregnancy
No-risk = Screening ICD-9 code
High-risk = V15.89 ICD9 code

Hope this helps.

 

[prattkm]

795.08 is the diagnosis for Unsatisfactory cervical cytology smear. In the past, we have never billed for the repeat. Insurance companies will not pay it anyway.

Typically if a patient came in and asked for a pap even though she wasn't due yet:

If patient has Medicare, make sure to have the patient sign an ABN. Even if she does not have Medicare, it is important for the patient to understand that this may not be covered and she could be held responsible for the entire bill.

Hope this helps!