Coding an annual wellness exam for Medicare patient and the Pap smear

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Lathrop, California
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There is a discussion in our office about billing for Pap Smear on a Medicare pt. There is a problem in understanding the Medicare preventative coding of a Pap Smear. We received many denials recently because we were billing the 88175 with codes Z01.411 or Z01.419. They were denied due to the ICD-10 code. We were using the Z01.411 or the Z01.419. (encounter for gnycological exam with normal or abnormal findings.
I also want to make clear that we have an independent lab that bills the pap smear out with their own NPi and these codes are billed with the 81 modifier.

Can we go ahead and bill the 88175 code with the Z12.4. for the same reason as stated above. We have found it to pay in the past but what worries me is that Z12.4 somehow is stating something different but the end result is the same: looking for malignancy in the cervix. The other thing that worries me is that the code Z12.4 has an excludes that states: when screening is part of a general gynecological examination (Z01.4-) We are doing this billing as an annual gyn exam which inclides the pap smear. So is it appropriate to use 88175 or G0143? It's for a preventative care exam?

When can Z12.4 be used?
 
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masseytc

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Code G0101 is for Medicare (breast and pelvic exam only). Use this code for breast and pelvic exam (NOTE: has to be both breast and pelvic, not just one or the other, to use G0101), with diagnosis code Z01.419. If doing a Pap smear only, use CPT Q0091 with diagnosis code Z12.4. There is an excludes note stating you cannot use both of these diagnosis codes together. Hope this helps. :)
 
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Screening Pap Tests - page 16

PREVENTIVE SERVICES CHART
ICN 006559 October 2015
This educational tool provides the following information on Medicare preventive services: Healthcare Common Procedure
Coding System (HCPCS)/Current Procedural Terminology (CPT) codes; coverage requirements; frequency requirements;
and beneficiary liability for each Medicare preventive service.
Please note: The information in this publication applies only to the Medicare Fee-For-Service Program (also known as
Original Medicare). For additional guidance on the use of diagnoses codes, go to Pub. 100-04 Claims Processing
Manual, Chapter 18.

https://www.cms.gov/Medicare/Preven...wnloads/MPS-QuickReferenceChart-1TextOnly.pdf
 
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