Ob-Gyn Coding Alert

Reader Question:

Medicare Reimbursement for Pap Smears

Question: In the August 1999 issue (page 62) of Ob-Gyn Coding Alert, an article on Reimbursement and Coding Tactics for Pap Smears states that according to HCFA guidelines, when a Medicare patient presents for her Pap smear, pelvic and breast exam, the service can be billed to Medicare using HCPCS Q0091 (collecting for Pap smear specimen) and G0909 (performing the pelvic and clinical breast examination).

This information conflicts with the information in Medicares Local Medical Review Policy, effective Jan. 1, 1999. It says, Code Q0091 refers to preparing and conveying a screening Pap smear to the laboratory. This code is reimbursable ONLY when it is the sole service provided during the encounter. Please let me know which of the above statements is correct.

Debra Behrens
Seattle OB/GYN Group
Seattle, Wash.

Answer: Per the Medicare Correct Coding Initiative, effective April 1, 1999, Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) may be billed with a separately identifiable evaluation and management (E/M) service on the same day, if performed by the same physician. Modifier -25 should be appended to the E/M service. Of course, its still a good idea to verify this information with your local carrier.