Ob-Gyn Coding Alert

Question: I-m wondering about Pap smears and risk factors. I know that for a Medicare patient, she has to have more than five partners or had sex before she was 16, etc., to make her high-risk. What about the patient who has had cervical or uterine cancer? Shouldn't she be high-risk for vaginal cancer?


New Mexico Subscriber
Answer: If the patient has had cervical or uterine cancer, then every Pap smear is a diagnostic smear, not a screening smear.

When the Pap is a diagnostic smear, however, Medicare expects you to also bill an E/M service. But when you bill an E/M service related to cancer follow-up and collect the diagnostic Pap specimen at that visit, payers won't cover the collection separately. Instead, payers will bundle it into the E/M service. In other words, you won't be able to report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).

If the woman is of childbearing age and had the cervical or uterine cancer within the last three years, she can have a screening Pap every year until she reaches no cancer for three years. At that time, your coding will be in the diagnostic Pap category, or your physician may choose  just to bill Medicare every two years for a screening Pap.