S0612 is a code developed by BCBS plans for their purposes and the code was incorporated into the HCPCS coding system in 2000. And yes, the typical gyn exam would include a breast exam so if one is not documented or performed this code would note represent the service. However, each BCBS plan does not follow the same rule when it comes to the use of S0612 and some plans ask that the code be used with preventive visit codes to explain that this exam, rather than being performed by a primary care physician who might have done a complete exam in the same year, was performed by an ob/gyn. It would be good to check the BCBS payer you are billing to ensure you understand how they want this code to be reported and under what circumstances.
I would not be correct to bill the lab codes for the pap smear unless your office owns a lab that performed the test on the sample or you are paying an outside lab to do so. Only the lab that does the actual smear interpretation should be billing a lab code.Hi Gator
No do not use S0613 or S0612 because not covered by Medicare per HCPCS manual 2023. For pap labs related to OB/GYN our docs use 88305, 88143, 88141. But pap and breast exam use G0101 and if annual physical use CPT 99396 per age or est. or a new patient. The dx code Z01.411 or other related to female GYN problems such as N83 N73 N80 N85, Etc.. If pt has OB/GYN problem (not annual physical) a new problem & documented use an Ev Mgnt code.
I hope this data helps you
Lady T