Pap Smear Coding

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3
Location
Austin, Texa
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We know these are usually not paid seperately when doing a preventative service however we are confused about correct coding for the office.
99395 E&M
88142 Pap Smear
99000 Specimen Handling
Is this correct?
Thanks we are so confused!
Jan:confused:
 

sdeaton

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El Paso
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88142 can not be billed by a physican office; only by the laboratory where the specimen was submitted for testing.

A few carriers may still reimburse 99000 but most do not. The reason being is that the laboratories tend to provide offices with the supplies (and requisition forms) at no charge and generally have a courier pick up the specimens at no charge. Since you are not charged for supplies or pick up, you should not bill (or expect reimbursement) for 99000.
 

dabroussard

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pap smear coding

what i would use for the diagnosis is V72.32 and for the pap Q0091 for the office portion. If the do wet mounts or KOH those can be coded if done and interpreted in the clinic
 

scottshar

Contributor
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Spokane, WA
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Hi Jan,
For regular annual pap, we use v72.31 as primary dx, 99394-99397 (age appropriate E/M) and either Q0091 or 88150 for the pap (88150 is a CLIA waived test and may be reported if performed in the clinic with QW modifier since this is a manual screen done by provider). Some payors accept Q0091 and others accept the 88150 so you would need to call your carriers for clarification. CMS accepts G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148 and Q0091. Annually, if high risk or every 24 months for all other if pt is Medicare/Medicaid. You will need to get with your providers and go over these codes to obtain clarification of which one fits best for your office procedures being performed.
 

aguelfi

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I'm new to this speciality so can you clarify for me if you bill 99387, G0101,
Q0091 and when? 99387 w/ a problem?? and G0101 for annual?? for medicare pts for medicare pts. what code do you use for the pap for primary insurances?
 

pammalou

Networker
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59
Location
St. Cloud, MN
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I am new to this specialty as well and I am struggling with papsmears as well. It looks like we are getting reimbursed for the H&P and not at all for any collection, conveyance or any of the papsmear and pelvic exam, just the H&P only. Is this correct? If medicare pays for it, why can the others not?
 

vegjas12

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Independant Lab

I'm new to Pathology and we are having a lot of trouble getting our paps and HPV's paid due to routine services. We billed a G0123 with Dx V72.32 and the denial from Medicare states the diagnosis is inconsistent for the procedure. From my understanding when the diagnosis is a screening then we bill with HCPCS and if it's a diagnostic then we bill medicare with the CPT (88141 or 88142) can anyone tell me how our lab should be billing when it's a screening vs diagnostic?
 

jmarjenhoff

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response

88150 is for the pathology lab's interpretation of the pap smear, not the
collection. Pap smears are NOT CLIA-waived, as they have to be read by
a licensed cytotechnologist or physician pathologist. If the pap/pelvic is done
for screening, the preventive medicine CPT codes include this. If the pap/
pelvic are done because of a problem, make sure you do not list a screening
V-code as the diagnosis. The extent of the exam, ie. the extra time and
effort to do the pap/pelvic for the patient with a complaint should be reflected in your E/M coding. The more extensive the complaints, exam, and
medical decision making, the higher the E/M code.
-MBC professor
 

suzhowell

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Still Confused and needing help!

We have two family practice Dr.s that have joined our practice that perform paps and pelvic exams. I am very confused on how to bill these procedures. We are not being reimbursed for the procedure.

Scenarios:

Pt comes in (Medicare) for an annual with pap... Do I bill 99397 and Q0091 with V70.0, V72.31? Should I expect reimbursement for E&M and procedure? :confused:

Pt comes in (Commercial) for an annual with pap... Do I bill 9939? and 88142 with V70.0, V72.31? I am under the impression that with an annual the pap is included. :confused:

Pt comes in with a problem, Medicare/Commercial....Do I bill E&M (99201-99215), with 88142? And should I expect reimbursement on both? :confused:

Your assistance will be much appreciated!
 

gamecocknana

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Pap Smear

I am new to Primary Care, worked in Cardiology. However, there is some confusion with patients who come in for a annual pap smear or there is a problem that results in a pap smear. Would age appropriate E & M codes be used or would you use the 8000 series for pap smears?
 
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