IM DOC BILLING PAPS - need help coding!

beckycmbs

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We have a new IM doc and have never billed for Pap tests before. The doc's husband is questioning their old ways of billing and I'd like to be sure to give him a correct answer. I've been doing a lot of research but would like you expert opinions! Please help! Thanks so much! This is what the doc's office has been doing up until this time:

Scenario 1: Commercial Insurance - annual pap plus management of other medical problems. Office collects the sample and sends it to an outside lab. They are currently billing 992XX (OV) w/ ICD-10s AND 88142 w/ Z01.411 or Z01.419?

Scenario 2: Commercial Insurance - annual pap only. Office collects the sample and sends it to an outside lab. They are currently billing 993XX(prevent med) w/ Z01.411 or Z01.419 AND 88142 w/ Z01.411 or Z01.419?

Scenario 3: Medicare patient - annual pap plus management of other medical problems. Office collects sample and sends it to an outside lab. They are currently billing 992XX (OV) w/ ICD-10s AND G0101 w/ Z01.411 or Z01.419?

Scenario 4: Medicare patient - annual pap only. Office collects the sample and sends it to an outside lab. They are currently billing 993XX(prevent med) w/ Z01.411 or Z01.419 AND G0101 w/ Z01.411 or Z01.419?

Finally, if a repeat pap is performed to confirm an abnormal test result, or because the lab sample didn't contain sufficient cells, how would that be billed to either a commercial or Medicare payer?

Thanks in advance AAPC experts!!! :)
 
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You actually have a couple of things going on here. I'm short on time, but here's some info for the Medicare portion:

Medicare covers screening paps and screening pelvic exams every 24 months, or every 12 months for high risk women or women of child-bearing age who have had an abnormal pap (basically) in the last 3 years.
Medicare divides up Screening Pelvic Exams G0101 and Screening Pap Tests (multiple codes here). If the patient has both, you bill the code for the pelvic exam separate from the code for the pap.

The problem, however, is billing for these services in conjunction with any E/M service. The screening pelvic exam and pap tests are preventive services and therefore are provided at no cost to the patient. But when you include them with an E/M code, the patient will then end up having to pay for the E/M services. Whereas, if the patient comes in just to have the pelvic and pap, you charge for the exam G0101 and the pap code, and the patient will not be charged as Medicare covers it (making sure you use the appropriate Z-codes).

If the pap test comes back as abnormal, then the services have shifted from preventive to diagnostic and will need to be billed accordingly.

Here's a couple of links
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf
https://www.cms.gov/Medicare/Preven...wnloads/MPS-QuickReferenceChart-1TextOnly.pdf

I'll try to get back to you tomorrow with more information if someone else hasn't already provided it.
 
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