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Thread: Pap Smear Coding

  1. #11

    Unhappy Independant Lab

    AAPC: Back to School
    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?

  2. #12

    Default 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

  3. #13

    Question 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.


    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?

    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.

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

    Your assistance will be much appreciated!

  4. #14

    Default 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?

  5. #15
    Join Date
    Apr 2007
    Columbia, MO


    Performing the PAP is part of the visit the lab codes are for lab use

    Debra A. Mitchell, MSPH, CPC-H

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