Primary Care Coding Alert

Question: What CPT® code should we submit for a Pap smear?

Rhode Island Subscriber

Answer: Your code choice depends on whether the patient is covered by Medicare and whether the physician collects the Pap smear for screening or diagnostic purposes. For Medicare patients, you can code for obtaining a screening specimen by reporting HCPCS code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). Typically, the physician collects the Pas smear in conjunction with a screening pelvic and breast examination, which may be separately reported to Medicare with HCPCS code G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination).

Explanation: CPT®'s Pap smear codes, such as 88175 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision), represent the pathologist's interpretation work. CPT® does not have separate codes for reporting obtaining a Pap smear specimen, because CPT® considers it inherent in the procedure or other service being performed (such as an office visit).

For non-Medicare patients and for Medicare patients having a diagnostic Pap smear, you cannot report obtaining a Pap smear specimen separately. Instead, you should report a code for the encounter during which the physician collects the Pap smear specimen. You'll likely submit a preventive service code or a standard office visit code (9920x or 9921x), depending on the nature of the encounter.

Screening Pap smears are a separate benefit under the Medicare program, which is why Medicare has HCPCS code Q0091 for this purpose.

Other tips: Medicare covers Pap smears and screening pelvic exams once every 12 months for women who are of childbearing age and have had an exam in the previous three years that indicated the presence of cervical or vaginal cancer or other abnormalities; or who are considered high risk for developing cervical or vaginal cancer. Women are considered to be at high risk for cervical cancer if they:

• Engaged in sexual activity before the age of 16;
• Had multiple sexual partners (5 or more in a lifetime);
• Have a history of a sexually transmitted disease (including the human papillomavirus and/or HIV infection);
• Had fewer than 3 negative or no Pap tests within the previous 7 years

Pap smears and pelvic exams for all other women (low risk) are covered every two years.