Oncology & Hematology Coding Alert

Question: During a chemotherapy treatment, a Medicare patient requested a Pap smear, which my oncologist performed. How should I code for the Pap smear?

Nebraska Subscriber Answer: First, you must differentiate between screening and diagnostic Pap smears. For screening Pap smears, you can report HCPCS codes G0124 (Screening cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician), G0141 (Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician) and P3001 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician).

CMS places statutory limitations on the frequency that you can report screening Pap smears: The patient hasn't had a Pap smear in three years or is of childbearing age, or the patient's medical history suggests that she has a high risk of developing cervical cancer and her physician (or authorized practitioner) recommends that the patient undergo the test more than every three years. High-risk factors include multiple sexual partners, history of sexually transmitted disease, and fewer than three negative or any Pap smears within the last seven years. If you report a diagnostic Pap smear, use +88141 (Cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]). For CMS to consider a diagnostic Pap smear medically necessary, CMS states that the patient must have one of the following conditions:
   previous cervix, uterus or vaginal cancer that a physician has or is treating
   previous abnormal Pap smear
   abnormal findings of the vagina, cervix, uterus, ovaries or adnexa
   a significant complaint concerning the female reproductive system
   signs and symptoms that the physician relates to a gynecologic disorder.