Primary Care Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.
Question: A patient came in for an annual exam and was menstruating, so the doctor was not able to perform the Pap smear. She came back for a Pap-only appointment. There is no code for just a Pap, and I'm afraid the office visit codes will be denied because the doctor is not examining the patient for anything else. How should we code? Alabama Subscriber Answer: Because there is no code for collection of a Pap smear specimen only, you must pair either an office visit code or a preventive medicine code with V76.2 (Special screening for malignant neoplasms; cervix; routine cervical Papanicolaou smear; excludes that as part of a general gynecological examination). Make sure the physician documents why the patient came in for a Pap only, so the payer will understand why you're using these codes together. Your other option is the preventive medicine codes (99391-99397) with V76.2. Because the patient is not receiving a full preventive exam, consider appending modifier -52 (Reduced services) to the codes to indicate that the service is reduced. Carriers usually demand a note explaining why the services were reduced. When using modifier -52, do not reduce the price of the procedure. Bill it at full price, and the carrier will make the reduction.

If your physician interprets the Pap, you can also bill the cytopathology codes (88141-88155 or 88164-88167). However, most family practices send the Pap smear to an outside lab. In that case, the lab will bill those codes, and you cannot. Some practices that have contracts with the lab make arrangements to pay the lab and bill the cytopathology codes themselves. Many coders say paying the lab to interpret test results and billing the insurance companies themselves can be a revenue-booster. Check to see what type of contract you have with your lab and compare costs.