Focus In on E/M Visit for Patient Returning for a Repeat Pap Smear
When a patient returns due to abnormal Pap smear results or insufficient cell samples, it's essential to report the follow-up procedures accurately.
Em Visit Patient Returning for Pap Smear
When a patient returns due to abnormal Pap smear results or insufficient cell samples, it's essential to report the follow-up procedures accurately.
In such cases, the OB-GYN will typically perform a repeat Pap smear to ensure an accurate diagnosis. Proper evaluation and management (E/M) and precise diagnosis coding are crucial for securing the appropriate reimbursement. By adhering to these coding standards, you ensure that your practice receives the ethical compensation it deserves for the care provided during these critical follow-up appointments.
Focus on Your Visit Code for Patient Returning for a Repeat Pap Smear
When a patient returns for a second Pap smear, submitting the correct Evaluation and Management (E/M) service code is essential. Since CPT does not provide a specific code for performing the Pap smear, you should use the appropriate office visit code, ranging from 99211 to 99215.
In most cases, you’ll likely report code 99212 for the Pap retest visit, as the patient is present primarily for the Pap smear. According to the Medicare Physician Fee Schedule national rate, this translates to approximately $57 per visit.
Specifically, code 99212, which covers an office or other outpatient visit to evaluate and manage an established patient, carries 1.68 relative value units (RVUs). When multiplied by the 2023 conversion factor of 38.8872, it results in $56.88 per visit. Ensuring accurate coding facilitates proper reimbursement and upholds the integrity of your billing practices.
Bill Policies For Private And Medicare Payers - Billing For Repeat Pap Smear
Understanding the policies of both private payers and Medicare is crucial when it comes to billing for a repeat Pap smear.
- Private Payers: Some private insurance providers may reimburse for handling a repeat Pap smear specimen using code 99000 (Handling and conveyance of specimen for transfer from the office to a laboratory). However, according to CPT guidelines, you should only report this code if your office incurs additional expenses beyond the average costs, such as paying for courier services or using office equipment to process the specimen before sending it to the lab.
- Medicare: Medicare carriers, on the other hand, view the collection and handling of the specimen as part of the E/M service when it’s performed for diagnostic purposes. Therefore, you should not bill separately for specimen handling. If the Pap smear is repeated due to an abnormality, you cannot bill Medicare with code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for the repeat procedure.
ICD-10-CM CodesFor Repeat Pap Smear
When coding for a repeat Pap smear due to abnormal results, use the ICD-10-CM code R87.61- (Abnormal cytological findings in specimens from cervix uteri). This code requires a 6th character to specify the exact nature of the abnormality, and failure to include this character could result in a claim denial.
Example: Consider a 36-year-old woman with multiple sexual partners who presents for an annual exam after not having had a Pap smear for four years. Her Pap results return with ASC-US (Atypical Squamous Cells of Undetermined Significance).
The physician advises her to return for a repeat Pap smear in four months to monitor abnormal cell progression.
When the patient returns, you should code the office visit with R87.610 (Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)), reflecting what is known about the patient’s condition at the time of the repeat Pap smear.
Scenario - Inadequate Pap Smear Samples
When a second Pap smear is necessary because the first sample was inadequate—for instance, if the lab could not interpret the results due to insufficient cells—you should report the diagnosis code R87.615 (Unsatisfactory cytologic smear of the cervix).
Example: Suppose an OB-GYN attempts to collect a Pap smear from an obese patient but misses the cervical opening, leading to a result that lacks endocervical cells. The physician would likely require another Pap smear. You would report the second Pap smear using diagnosis code R87.615 for non-Medicare patients.
Medicare Patients
The approach differs for Medicare patients. In this scenario, you would use diagnosis code Z12.4 (Encounter for screening for malignant neoplasm of the cervix) if the repeat smear is part of a routine re-screening.
If the patient is considered high-risk, you would instead use Z77.9 (Another contact with and [suspected] exposures hazardous to health). For Medicare, the repeat Pap smear should be billed using code Q0091 (Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory) rather than an E/M service code, as Medicare views this as a screening.
Additionally, since the procedure is repeated, you should append modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) to the Q0091 code to indicate that the same physician is performing the repeat Pap smear.
Choose BillingFreedom for Accurate Pap Smear Billing
At BillingFreedom, we work to provide accurate OBGYN Medical billing for Pap smears for every situation – for abnormal results, inadequate samples, or repeat tests. Our problem-solving focus is on E/M and diagnosis coding that covers proper or improper usage of codes such as R87.615 & Q0091 with modifier 76 ensures that your practice gets the right amount of reimbursement it deserves. With Medicare and other private payers, we take charge of billing’s challenges, leaving you to do what you do best – care for your patients.
Deem BillingFreedom is your trusted partner for effective and efficient medical billing that can help you achieve your revenue goals without compromising quality and compliance. For more details about our exceptional medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472. Your financial tranquility is our priority!
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