Wiki Pap Smear without full GYN Well Women Exam

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y2rv

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Hi,
My provider did a GYN exam with pelvic and pap smear and only addressed the pap smear on her note but did not complete a full GYN Well Women Exam. When I queried provider she stated she only did a pap smear. Would this be coded with an E/M and DX Z12.4 or will not billable at all?? Thank so much for any help/guidance.
 
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Some additional context could be helpful.
Was there a problem oriented E&M service provided? If so, then an E&M with that diagnosis should be billed.
Sometimes a patient comes in for a regular annual well exam (either well woman or general preventive by PCP), but has her menses, so is instructed to come back another time for PAP.
Was the PAP purely a screening? Or did the patient have a recent insufficient PAP being repeated? Or a recent abnormal PAP and this was diagnostic?
Some carriers other than Medicare will recognize and pay for Q0091 or G0101, which may be an option.
 
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csperoni said:
Some additional context could be helpful.
Was there a problem oriented E&M service provided? If so, then an E&M with that diagnosis should be billed.
Sometimes a patient comes in for a regular annual well exam (either well woman or general preventive by PCP), but has her menses, so is instructed to come back another time for PAP.
Was the PAP purely a screening? Or did the patient have a recent insufficient PAP being repeated? Or a recent abnormal PAP and this was diagnostic?
Some carriers other than Medicare will recognize and pay for Q0091 or G0101, which may be an option.
Click to expand...
No there was nothing else. Patient scheduled visit for GYN Exam/Pap smear. The provider only did the pap smear, there is no other chief complaints or problems to bill for and per provider she didn't complete a full well woman exam, she stated it was just the pap smear.
 
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Hi Y2RV,
Umm yes sound like need more info on why was pap completed if not done for annual reasons. Does the documentation show why patient was having GYN problem to warrant a pap done? Here are some dx code used before for only our female pts. needing a pap only, but not really a wellness check done as annual preventive visit. Is there more written documentation to support any of these illness such as: dx block N93. N76.1 N89, N92, N77, D25, and dx Z01.4 orZ12.4? Also anytime pap done the payer wants LMP (last menstrual period). This is data been told by payer. Docs usually do lab test CPT 88142 from uterus smear on checking up that area.
Well hope this data is helpful
Lady T
 
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TThivierge said:
Hi Y2RV,
Umm yes sound like need more info on why was pap completed if not done for annual reasons. Does the documentation show why patient was having GYN problem to warrant a pap done? Here are some dx code used before for only our female pts. needing a pap only, but not really a wellness check done as annual preventive visit. Is there more written documentation to support any of these illness such as: dx block N93. N76.1 N89, N92, N77, D25, and dx Z01.4 orZ12.4? Also anytime pap done the payer wants LMP (last menstrual period). This is data been told by payer. Docs usually do lab test CPT 88142 from uterus smear on checking up that area.
Well hope this data is helpful
Lady T
Click to expand...
Just wanted to clarify that 88142 is usually for the LAB/PATHOLOGIST, not for the physician collecting the specimen. I realized it may be different in more rural areas, but I've been working in gyn/gyn specialties for 18 years and have never come across an obgyn INTERPRETING the PAP. It is always sent out to be analyzed. Q0091 is the Medicare created code for "screening PAP smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory" which may or may not be recognized and/or paid by other carriers.
I have also never come across carriers requesting LMP for PAP. Only for maternity care (O dx codes).
 
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Hi Csperoni,
The doctor I am referring to is the pathologist to read the lab results of CPT 88142. Our payers anytime a female patient gets a pap the payer request the LMP. The providers put it in the medical documentation . Payer rules can change which can be the nature of their business at times.
Lady T:)
 
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Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?
 
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vnorman said:
Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?
Click to expand...
Many payers will not reimburse separately for Q0091 when performed with a prevent or other e/m service; eg, Anthem does not allow when either prevent or problem e/m are same day. UHC will not pay when performed with prevent, etc.
 
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vnorman said:
Our office is having an issue with reimbursement for Q0091. I thought DX code Z12.4 was a medically necessary code but it continues to get denied stating it is inclusive of another service. I have added the -25 to the Wellness Visit or E&M but I still have not luck. Any advise?
Click to expand...
Agree with @Cmama12. Q0091 is a Medicare code that only some commercial carriers will pay. There are carriers that will bundle Q0091 into any E&M or preventive visit regardless of how many modifiers you put. If you are receiving denials, you should check that carrier's policy.
 
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