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Ob-Gyn Coding Alert

Reader Question :

Diagnosis Codes Critical for Annual Exam

Question: Our ob-gyn saw a Medicare patient for an annual exam with a Pap smear collection. I coded V72.3 and V76.2. Medicare didn't pay, but it said the patient was eligible to have an annual and Pap. How should I have reported this service? Pennsylvania Subscriber Answer: For this preventive medicine exam, you should have billed G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the pelvic and breast examination. And you should have reported Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for the Pap smear collection. Link both services to V76.2 (Special screening for malignant neoplasms; cervix). If the patient had no uterus and the surgeon performed the hysterectomy for nonmalignant reasons, you should submit the claim with G0101 linked to V76.49 ( other sites) and Q0091 with V76.2. On the other hand, if the patient had not had a Pap smear in seven years, you would code G0101 and Q0091 with V15.89 (Other specified personal history presenting hazards to health). If you try to bill the preventive medicine codes (99381-99397), note that Medicare never reimburses for this service.  

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