Pap Smear Only

Kris Cuddy

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Harrison, MI
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What prompted the patient to make an appointment for a pap smear without a gynecological examination, or a preventive health maintenance examination?
 

dballard2004

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Overland Park, Kansas
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Usually they are getting the pap because the male doctor does the preventative service and they want a female doctor to do the pap. OR they are on their cycle during the preventative visit and are rescheduled to do pap.

The female doctor always does a pelvic with a pap and she does obtain and/or review the GYN history.

How would this be coded?
 
Messages
114
Location
Madison Area Chapter in Madison WI
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My understanding when the initial provider does part of the preventive service and the patient sees another provider in the same group for the remainder of the services the entire service is submitted as one preventive code. I think this is fairly common due to gender or cycle issues.
 

Kris Cuddy

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Harrison, MI
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For the patient's who want their gynecological services performed by the female provider in the office, is there a reason why they are then scheduled with the male provider?

In my honest opinion, I would be very unhappy with my doctor's office if I only wanted my gynecological services performed by the female provider in the office but they wanted to schedule my full preventive with the male doctor.

This being the case of what actually happened, does not take away from the fact that there are two separate dates of service and two separate services being performed. It is imperative to check with the patient's carrier. Each carrier has differing policies on how often preventive services may be billed and how they may be billed.

For example, in Michigan, BCBS of Michigan requests separately provided gynecological services be billed with S0610 or S0612, or G0101 if the patient is high risk, and Q0091 if there was a pap smear collection taken. These codes would be billed if the gynecological services were provided on a separate date of service from a preventive maintenance examination, whether the same provider or different.

Also, Medicare allows preventive maintenance examinations and gynecological services billed on the same date of service. In addition, if a separately identifiable E/M is performed that is also billable.

Another carrier, SPHN, allows multiple preventive E/M's (9938X - 9939X) billed throughout the calendar year. SPHN indicates they expect the diagnosis code to advise what was done, e.g., V70.00 for the routine preventive and/or V72.31 (example only) for the gynecological services for a patient who has not had a hysterectomy.

In my honest opinion, I would not just include this service in the original preventive examination. It is possible to lose out on completely appropriate reimbursement by doing that.

Hope this helps.

Kris
 

kbarron

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Ossipee, NH
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Pap

We have a MD who does not do paps. They are sent to gyn MD and is coded with Prev med code and w/V72.31 for non medicare pts. We use V15.89 or V76.2 which ever is appropriate for Medicare pts with the GA modifier if abn signed.
 
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