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Medicare Pap - confused on how to code

  1. Default Medicare Pap - confused on how to code
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    I am confused on how to code a Medicare Pap. I haven't done these enough to really know the correct way. I use the V72.31 with the G0101 and the Q codes. The Q code I don't know right off the top of my head. Is this the correct way? What about the CPT code? If the pt is over 65 use the 99397? Any thoughts on this?

  2. #2
    Medicare does not cover preventative visits, the 99387/99397 will not be covered. What Medicare will cover is the G0101 w/ V72.31 for cervical cancer screening, pelvic, and breast exam and the Q0091 w/V76.2 for the pap. Medicare will cover these services every year IF the patient is of childbearing age or high risk, for all other patient it is covered every other year. If you are unsure when the last exam was done, it's always better to get an ABN signed.

  3. Default Medicare Pap
    You do not use the 99 CPT codes for the well woman exam for Medicare patients, period. You bill the visit with G0101 w/V72.31 and bill Q0091 w/V76.2 for obtaining the Pap Smear. The Lab company you send the specimen to will bill also for the Pap. Medicare is one of the few rare companies that allows you to bill for "obtaining". Hope this helps.

  4. #4
    Columbia, MO
    You do not code the V76.2 with the V72.31. Check your ICD-9 book you will see that the V76.2 is inclusive to the V72.31. If the patient has had a total hysterectomy then you are not doing a cervical pap you are doing a vag pap so you must then add the code for the vag pap. I think this is V76.47 and also the V code for the absense of the uterus. The code book also directs you to do this.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default Medicare pap
    Thank you for your input. I appreciate it.

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