Ob-Gyn Coding Alert

Question: My office did a repeat Pap smear for a previous insufficient specimen, and Cigna reimbursed the service only $8. I called the rep, and he said I needed to use a modifier. Cigna covers $8 for Q0091 but nothing for the office visit, because the rep said the E/M was integral to a more complex primary procedure. What should I do?

North Carolina Subscriber

Answer: You probably need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to your E/M code (such as 99201-99215, Office or other outpatient visit ...). You should link the E/M code with modifier 25 to 795.08 (Unsatisfactory cervical cytology smear).

Payment, however, isn't a sure thing. Your carrier might consider the Pap collection as included in the E/M service. In other words, if the patient returns for a "re-Pap" due to an unsatisfactory smear, and the physician performs no additional service, you should not report the office visit. Instead, charge only the collection.

To Medicare and other carriers that recognize the HCPCS level-II Pap smear code, report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).Indicate a repeat Pap smear by attaching modifier 76 (Repeat procedure by same physician) to Q0091. A few payers may reimburse for 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) instead.

Report Q0091-76 or 99000 with one of four V codes:

• V76.2 -- Special screening for malignant neoplasms, cervix

• V76.47 -- Special screening for malignant neoplasms, vagina

• V76.49 -- Special screening for malignant neoplasms, other sites.