Internal Medicine Coding Alert

Published on Sat Apr 01, 2000 PDF

Question: We have been billing Medicare patients with the G0101 and Q0091 codes for collecting Pap smear and pelvic/breast exams. What are the equivalent codes for commercial insurance companies? We have been using the same codes for commercial claims and some recognize them and some do not. I am unable to locate similar codes in the CPT manual.

Ohio Subscriber

Answer: There are no equivalent CPT codes for G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) or for Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management consulting firm in Spring Lake, N.J. Code 99000 (handling and/or conveyance of specimen for transfer from the physicians office to a laboratory) can be billed when the physician must pay for the specimen (i.e., Pap smear) to be transported from his office to the laboratory.

If that were the case, 99000 would be used to code for the transfer of the specimen. But there is no CPT code for collection of the Pap smear. CPT has preventive-medicine codes, which are used to report preventive-medicine evaluation and management services of infants, children, adolescents and adults. These codes are based on the age of the patient.

New patient preventive-medicine codes are 99381-99387, depending on the age of the patient. Established patient preventive-medicine codes are 99391-99397, depending on the age of the patient. These age-appropriate codes are used to report well-woman exams, usually in the range of 99384-99387 for a new patient and 99394-99397 for an established patient.

A well-woman exam is more detailed than a pelvic/breast exam and includes a comprehensive history, comprehensive genitourinary exam, which includes performing and documenting at least seven of the 11 elements of the genitourinary section of the 1997 genitourinary single organ system exam. You may want to check with your physician to see if he or she is performing a well-woman exam, and if the preventive medicine codes are appropriate.

Commercial payers do not always follow Medicare guidelines, so you should check to find out if they require a specific code for reimbursement of collection of Pap smear and pelvic/breast exam.