I work for Peds,but in our coding newsletter from American Academy of Pediatrics, this is the article that was for PAPs. It does say PAPs are included in the Preventive Exams and it not sepratley billed.Hope this Helps
Perplexing: Reporting Pelvic Examinations and Papanicolaou Tests
Under Current Procedural Terminology (CPTÂ®) guidelines, a pelvic examination and obtaining a Papanicolaou test (also known as a Pap smear) are components of a physical examination and therefore are not separately reported. The testing and interpretation of a Pap smear is performed and billed by a laboratory and not a physician. However, as always, there is some confusion about reporting these services because Medicare guidelines differ. To help allay any further confusion, the guidelines for reporting these services are outlined herein.
The Pap Smear
CPT codes 88141â€“88154, 88164â€“88167, 88174, and 88175 are used to report the various methods of Pap smear screening and the physician interpretation. The primary care physician does not report these codes. However, CPT code 99000 (handling or conveyance of specimen for transfer from the physician's office to a laboratory) may be reported in addition to reporting the preventive medicine or problem-oriented visit.
When Performed as Part of a Problem-Oriented Evaluation and Management Visit
The pelvic and breast examination (with or without obtaining a Pap smear) is a component of the genitourinary system examination. If using the 1995 Documentation Guidelines for Evaluation and Management (E/M) Services, the complexity of the examination (problem-focused versus expanded, detailed, or comprehensive) is determined by the number of body areas or organ systems examined. Under the 1997 guidelines, the complexity is determined by the number of specific bulleted elements performed (eg, external genitalia normal, cervix normal without discharge). Under either set of guidelines, the examination complexity will be higher when a pelvic and breast examination are performed if medically necessary because the examination is more detailed. However, remember that the physical examination is only 1 of the 3 key components required in the selection of the E/M service.
If counseling or coordination of care (eg, prevention and symptoms of sexually transmitted infections, contraception) requires more than 50% of the total face-to-face time for the encounter, time may be used as the key or controlling factor in the selection of the code level.
Any additional tests (eg, wet mounts) may be reported in addition to the appropriate-level E/M code.
When Performed as Part of a Preventive Medicine Visit
Preventive medicine visit services (99381â€“99397) include a comprehensive (age- and gender-appropriate) history and physical examination that are not synonymous with the history or physical examination components in problem-oriented codes. The CPT guidelines stipulate that preventive medicine services provided to patients from ages 12 through 39 years (CPT codes 99384/99394 and 99385/99395) include the pelvic and breast examination and obtaining a Pap smear.[/COLOR]
Tip: Some physicians, because of scheduling and time restraints, want the patient to return for a separate visit to perform the pelvic examination and Pap smear. Note that the service is still considered part of the preventive care service and would be reported with code V20.2. Therefore, it would not be billable as a separate visit.
Counseling, anticipatory guidance, and risk factor reduction intervention (including routine management of contraception) are also included in the preventive medicine service.
Any additional screening tests or other procedures that have a CPT code may be reported separately.
If at the time of a preventive medicine service a patient is experiencing a problem or abnormality (eg, vaginitis, dysuria) that requires additional work to perform the required key components of a problem-oriented service (history, physical examination, medical decision-making), a separate E/M service (99201â€“99215) may be reported in addition to the preventive care service code. Modifier 25 would be appended to the office or outpatient code (99201â€“99215) to signify that a significant, separately identifiable E/M service was provided by the same physician on the same date of service. Code V20.2 (routine health maintenance, infant or child) should be linked to the preventive medicine visit and the appropriate diagnosis for the problem should be linked to the problem-oriented visit.
Tip: The selection of the problem-oriented E/M service would be dependent on the performance and documentation of the required key components (history, physical examination, and medical decision-making, or time) related to the problem or abnormality. The pelvic examination and obtaining the Pap smear may already be included in the preventive medicine visit (if age appropriate) and would not be used or counted again in the selection of the problemoriented E/M service code. Therefore, in many instances, the medical decision-making together with the history will be used to determine the level of service. If the physical examination component cannot be used, a new patient visit would be reported as a subsequent visit (99212â€“99215) because the required 3 key components of a new patient visit were not met.
Medicare requires that Healthcare Common Procedure Coding System code Q0091 (screening Papanicolaou; obtaining, preparing, and conveyance of cervical and vaginal smear to laboratory) be reported separately with the appropriate E/M service. Some Medicaid programs and commercial payers may also recognize code Q0091 as a separate service. If reporting Q0091, it is not appropriate to also report 99000.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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