Pap only visit

[espforu]

A patient came for a preventative med visit. She came back a few days later for the pap.

How should the pap visit be coded? It is not a preventative med visit nor a problem focused visit. In the past we coded just a problem focused visit.

Any thoughts?

TIA

 

[jvanek82]

What was documented? The doctor would need to document enough to bill for a problem focused visit. Why wasn't the pap done at the preventative visit and why did the patient come back for the pap? I would use a problem focused code if the documentation supports it!

 

[mitchellde]

A patient came for a preventative med visit. She came back a few days later for the pap.

How should the pap visit be coded? It is not a preventative med visit nor a problem focused visit. In the past we coded just a problem focused visit.

Any thoughts?

TIA

If there was some physiological problem preventing the PAP collection at the preventive visit then you do not charge for the return for just the PAP, since the collection is part of the preventive encounter. The question is why was it not performed at the time of the preventive.

 

[espforu]

Thanks,

There really is not enough documentation. I am not sure why it was not done at the time of visit.

No HPI or ROS, MDM pap done.

 

[mitchellde]

Thanks,

There really is not enough documentation. I am not sure why it was not done at the time of visit.

No HPI or ROS, MDM pap done.

Unless there is a problem dx or documentation that the patient declined the service and then decided to come in for the PAP only, there is no charge for a delayed PAP that us part of the preventive.

 

[vincil]

What code would you assign? or is it just included as the previous visit? I had that happen bc the patient had her children with her and wasn't able to do the exam.