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Gyn PAP Coding_ Commerical

Apurva Posted Wed 27th of November, 2019 04:39:44 AM
For the pap smear first visit we have billed 88175 AND 87624 with Z01.419 & R87.615 and we have received payment for commercial insurance. As the first visit was unsatisfactory the same test was repeated after 15 days . For the second visit we have been receiving denial stating " As the service was already paid for the first visit why should I pay for the second visit for the same test". Need guidance with the CPT and ICD billing for second visit
SuperCoder Answered Thu 28th of November, 2019 06:12:29 AM



If your patient’s Pap smear results return as abnormal or display insufficient cells, the ob-gyn will probably perform a repeat smear.

When the patient comes in for a second Pap smear, submit the appropriate E/M service. CPT does not include a code for taking the Pap, so you should use the office visit code (99211-99215).

You will probably report 99212 for the Pap retest visit because the patient is here only for the Pap smear.

That translates to almost $45 per visit, using the Medicare Physician Fee Schedule national rate. Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) carries 1.27 relative value units (1.27 RVUs x 2019 conversion factor 36.0391 = $45.77).


Some private payers will reimburse for handling the repeat Pap smear specimen (99000, Handling and/or conveyance of specimen for transfer from the office to a laboratory), but under CPT® rules, you should not report this handling code unless the office incurs an expense over and above normal costs (such as paying for someone to deliver the specimen or using office equipment to process the specimen before transportation).

But Medicare carriers consider the collection and handling part of the E/M service when it is done for diagnostic purposes, and you should not code for it separately. That is, if the Pap is repeated due to an abnormality, the code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) may no longer be billed to Medicare.


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), you should report R87.615 (Unsatisfactory cytologic smear of cervix).

For example, the ob-gyn misses the cervical opening when taking a Pap smear because the patient is obese. The Pap result indicates the absence of endocervical cells, and the physician likely would require another Pap. In this case, you would submit the second Pap screening with R87.615.

When this occurs with the Medicare patient, your diagnosis code changes to Z12.4 (Encounter for screening for malignant neoplasm of cervix) for a routine re-screening or Z77.9 (Other contact with and [suspected] exposures hazardous to health) if the patient was considered high risk. But remember, Medicare will require you to bill this repeat Pap using code Q0091 rather than an E/M service, because Medicare still considers this to be a screening.


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