Medicare follows its own
guidelines. So you need to tread cautiously.
You
are entitled to get paid for both services if your physician performs Pap
services when patients come for their yearly physicals. Here are some tips you
can apply when documenting the encounter and selecting the appropriate
diagnosis.
Be well-versed with visit codes
Normally,
you report an annual physical with a preventive medicine E/M code such as 99396 or 99397. Choosing the
correct code will depend on the patient’s age and whether the patient is new
(99381-99387) or established (99391-99397) with your practice.
What’s included: These codes include
the physical exam and also the ordering of laboratory/diagnostic
procedures such as Pap smear.
From CPT perspective: The services to get
the Pap smear are included in the procedure being performed and are not
reported separately.
· Use
99000
for the handling and conveyance of the specimen to an outside laboratory. But
watch out because many payers, including Medicare, consider this is a bundled
service and will not pay for it separately. This code is not a standalone code;
it is always to be reported in addition to the basic services provided. So in
this scenario, that would be a preventive medicine visit.
Medicare benefits cover a
screening Pap smear and cervical or vaginal cancer screening, including pelvic
and clinical breast examination. Since these are Medicare benefits and because it
does not cover the preventive medicine service codes that would otherwise
include the services, Medicare created separate codes for both benefits. You
should report the following codes when your physician provides services to a
Medicare beneficiary:
·
Q0091 (Screening
Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal
smear to laboratory)
·
G0101 (Cervical
or vaginal cancer screening; pelvic and clinical breast examination) when
your physician provides these services to a Medicare beneficiary
Private
payers don’t pay separately
Since
CPT® takes Pap smear collection to be
included in the visit being performed and since a breast and pelvic exam may be
deemed as part of “an age and gender appropriate…examination, many private
payers do not reimburse for Q0091 and G0101 when carried
out with a preventive medicine visit. There are some
private payers that might not reimburse for either code under any
circumstances, even if the Pap collection and preventive visit occur on
different days.
Remember: Don’t submit these codes to a
private payer with a preventive service code until you know that the payer
accepts and pays for them just like Medicare.
