Wiki Billing for Medicare PAP

[mm0105]

I know that medicare only pays for a pap smear every 2 years and I know how to properly code for that. Here is my issue: The provider in our office brought a Medicare patient in for an annual pap stating that she is high risk. She previously had an abnormal pap, which in turn ended up with a hysterectomy. What would the proper diagnosis codes be? V15.89 + ???

 

[m.j.kummer]

TO: mm0105 - Billing for Medicare PAP

If she had a hysterectomy for non malignant condition than use V15.89, V76.47, and (V76.49 if applicable).

If she had a hysterectomy for malignancy than V15.89, and V67.01

Make sure the high risk reasons are well documented.

 

[amjordan]

Medicare definition of High Risk and your providers may not be the same. Below is the Medicare High Risk definition. If the patient does not fall into one of the areas below, she does not qualify.

High risk factors for cervical and vaginal cancer include:
♦ Early onset of sexual activity (under 16 years of age),
♦ Multiple sexual partners (five or more in a lifetime),
♦ History of a sexually transmitted disease [including human papillomavirus (HPV)
and/or human immunodeficiency virus (HIV)],
♦ Fewer than three negative Pap tests within the previous 7 years, and
♦ DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy

Based on the information of "one abnormal pap" that does not qualify as high risk. This is one of those areas that can be confusing and you need to ask the question is this truly a "screening" pap and pelvic or is this "follow-up" care.