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Help!! Pap CPT Codes??

  1. #1
    Question Help!! Pap CPT Codes??
    Medical Coding Books
    My boss forwarded me the email another organization has asked regarding cpt's on paps. Unfortunantly we dont code cpt's on paps so I have no idea how to answer the question.

    Aparently they want to know the CPT code for a historical PAP? I've never heard of such a thing, but then Ive also never coded paps. Is there such a code? And if not, what are the common cpt codes used for a pap? How about an Abnormal pap re-screening?

  2. #2
    there is no CPT code for the collection of the PAP only a lab code. If your provider is only doing the collection you CANNOT use the lab code.

    there is however a HCPCS code
    Q0091 with V76.2 (or V72.31)

    you cannot use the Q code for repeat due to an abnormal result(795.xx). the repeat PAP is included in the E&M level.

    also if the patient is only in for a pap and a full prevent is not done look into code G0101. there are documentation requirements for this code too.

    these two codes work for Medicare but other carries reconize them too.

    hope this helps
    ps i have never heard the term historical pap either.

  3. #3
    Default pap
    Pap smears are included in E&M unless they are screening Q0091 which is used for medicare.
    Q0091 screening pap smears
    Attention: Practicing ACOG Fellows and Junior Fellows

    ACOG has recently received notice from several members that some private payers are demanding repayment of monies paid out for a screening pap smear collection using the HCPCS Q0091 code.
    ACOG's position on reporting to private payers the collection of the screening pap smear is that the collection of a pap smear specimen is always part of the E/M or preventive medicine service and should never be reported separately.
    ACOG's advice to members remains the same: practices should not bill the Q0091 code to private payers for screening pap smear collection. Q0091 is a code developed by Medicare for services provided to Medicare patients. Medicare does not reimburse for preventive services, such as those reported with CPT-4 codes 99384 - 99397. However, it does allow payment of Q0091 as an exception to its general rule.
    Similarly, collection of a diagnostic pap smear for a Medicare patient (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service and is not reported or reimbursed separately.
    Some private payers do reimburse for the Q0091 code. In such cases, ACOG strongly recommends obtaining the guidelines for that specific policy in writing.
    If a payer demands repayment of reimbursement relative to the Q0091 code, ACOG recommends that you contact legal counsel. State laws and regulations vary as to the time limits for the payment recovery period. However, when the recovery efforts are based on suspicion of fraud or misconduct on the part of the practitioner, there is no time limit for recovery.
    Susan Eosso, CPC,CMRS

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