Wiki Pap outside Preventive Visit

ELBrock

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I know this question has been brought up multiple times, but this situation is a little different:
A new patient presents for an annual exam in December. She states she would like to defer the pap until she gets records from her old OBGYN. She thinks she is not due for one yet.
We still billed the annual visit.
The patient returns 3 months later stating she got her old records and found she is actually do for a pap. The provider sees her, documents her history and explaining the situation, does a expanded-problem focused exam and takes the pap.
We are billing 99213 - with DX Z12.4.
From previous posts, it seems essentially agreed upon that you cannot bill a 99213 without an actual problem, and screening pap smears are not problem visits.
I did bring up UHC's reimbursement policy on Preventive Visits and Screening Services, and it states that screening services, such as a pap/pelvic exam, etc, are included in the preventive CPT when done on the SAME date. Since this is 3 months later, I feel that it's okay to seek payment with 99213 for this DX, lacking any other CPT to explain the service. This carrier does not accept Q0091.

Any thoughts?
 
I think the question is how does your provider get to a 99213 when she is only doing a pap? At my office, if a pt needed a "pap only" for reasons just like this, they just collected the pap and let the lab bill for the pap. If the provider did any follow -up on medications, etc, then you could also include those dx with your Z12.4 dx.

Sherrie Peterson, CPC, COBGC
 
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