Repeat Pap Smears

I wanted to know how to code a repeat pap smear when the patient has to come back for insufficient cells on the first sample. In my opinion, I would only charge the Q0091 and the 88142 with the diagnosis code 795.08 but the doctors at the practice where I work are also charging a 99212. I don't think that they should be charging for an additional office visit when no other problem is addressed. Am I correct? And is there any documentation that I can provide the docs to support this?

Thanks,
Jessica Lindholm, CPC

pap

If the patient requires a second Pap smear because the first sample was inadequate (that is, the lab did not have enough cells in the specimen to interpret the results), coding will depend on the payer. For the Medicare patient, you would report V76.2 (Special screening for malignant neoplasms; cervix) for the second smear. You should also report collecting it with Q0091 with modifier 76 (Repeat procedure or service by same physician) added for clarification.
Alternatively, some commercial payers, may use 795.08 (Unsatisfactory smear) if the first smear was inadequate, but require an E/M (99211-99215) depending on the services performed and documented that day.
Who is actually performing the pap smear? Medicare only allows the billing of the pap smear to the entity that actually performs the test (ex, lab).

Repeat Pap Smears

We perform the actual test here. We don't send it to an outside lab. The specific patient that I am inquiring about is 21 yrs old and has a commercial insurance. My main concern is that in billing an office visit (such as a 99212) it will generate a copay to the patient. I don't believe that the patient should be charged for something that wasn't her fault, which is why I think that I should only be billing the Q0091 and the lab charge 88142.

pap

I would not be billing Q0091 with code 88142 if performing the pap test in your office..

pap

I think that ACOG has addressed this, but can't find it on their website.

I agree with Nancy: Q0091 is for preparing and conveying the specimen, and if you are doing the pathology in your office for the pap smear, then I wouldn't bill the lab handling.

As for the second visit, I think you can bill a 99212, as long as their is documentation, from a coding perspective, and many offices do. Some offices don't bill for the office visit, mostly for PR reasons, and needing to collect a copay, as you said.