Wiki OV and Pap coding for IM doc?

[beckycmbs]

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!!!

 

[Kimberlyfaith]

Billing for annuals

Outside lab would be billing the 88142 code. The physician obtaining the pap would not bill this code. Only use Z01.411 if billing after receiving the pap results back and there is a problem otherwise always bill Z01.419. If billing an annual always bill the 993XX, but if it is Medicare bill G0101 and Q0091 (payable only every two years). If you are only obtaining a pap for a repeat to abnormal then usually bill a 99212 because only obtained the pap and will discuss the results when they come back. I only bill Medicare a 992xx with a G0101 if we are seeing the patient for a seperately identifiable reason during an annual and that 992xx documentation has to be able to stand on its own without the assistance of the documentation for the annual.

Kimberly McDermott, CPC, CPMA, COBGC