Wiki GYN Well Women Exam

[blazer01]

I'm new in the coding world and need some guidance on non-Medicare well women exams. If a pap smear was NOT done during the wwe only the the breast and pelvic do you still use the 99394-99397 (est patient) with appropriate z01.411/z01.419? Then if the pap smear was done would you add the Z12.72? I know you have the Q0091 for a pap, but not all commercial plans pay on that code.

Thanks in advance.

 

[cford0908]

Hi, For non Medicare payers, well women exams should be coded as 99394-99397 (est) regardless is a PAP was performed. If a pap was performed for a non-Medicare payer you can use code 87210-QW and link to Z12.4 or any complaint requiring a pap.

 

[csperoni]

Hi, For non Medicare payers, well women exams should be coded as 99394-99397 (est) regardless is a PAP was performed. If a pap was performed for a non-Medicare payer you can use code 87210-QW and link to Z12.4 or any complaint requiring a pap.

I agree with preventive medicine service codes for well woman even if a PAP is not performed. I'm pretty sure ACOG gave advice on this at some point, but don't have my reference handy.
I would just note 87210 Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) is something typically performed by a lab. I have never seen an office perform this service. It is not for PAP collection.
Q0091 is for collection of a PAP smear. It is covered by Medicare (with certain limitations). Private carriers may or may not pay for this separately and many bundle with the visit.

 

[blazer01]

Thank you very much for your responses, I really appreciate it. I will look and see if I can find the ACOG information you were talking about for future reference. Thanks again.

 

[csperoni]

I found the ACOG article. In fact, even if a pelvic exam was not done, but the rest of a well-woman was, preventive codes should be used.