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Patient returns for only a pap after already having a well woman exam

Tracy Posted Tue 16th of July, 2019 10:48:34 AM
Patient comes in for her well woman exam. All components of the well woman exam are performed except for the pap because she is not sexually active. If she becomes sexually active and returns to have her pap within the year, how would we bill for just the pap provided she has no other concerns or issues when she returns? Would it still be part of the WWE we previously performed and would not bill the pap? or would we be able to bill a low level E&M code?
SuperCoder Answered Wed 17th of July, 2019 05:01:44 AM

Hi Tracy,

Most pediatricians do not routinely include gynecological services, such as pelvic exams and Pap smears, as part of the comprehensive preventive medical exam.

Necessity of pap smear depends on whether patient is sexually active or inactive.

NOTE: The new recommendation on Pap smears by the American Cancer Society is that the patient does not need her first Pap smear until three years after the onset of sexual activity. So, a Pap smear in the first three years really isn't necessary.

Now, if patient comes for well women exam (WWE), we should use 99384 (Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, new patient; adolescent [age 12 through 17 years]) for new adolescent patients who are 12 through 17. If she becomes sexually active and returns to have pap within year. We will just bill codes from range 88141 through 88153 (depending upon method used), and diagnosis code as Z01.419, however, reimbursement depends upon payer policy. Feel free to ask for any further query.

NOTE: Use Q0091 when obtaining a screening Pap smear for a Medicare patient. But also check with your private payers to see if they allow it in connection with a preventive medicine service.

Tracy Posted Wed 17th of July, 2019 10:10:16 AM
Sorry for the misunderstanding. This is a 29 year old woman. We billed 99385 (Preventive-New Age 18-39). We just wanted to know if she came back for the pap is it billed as a low level office visit or do we not get to bill it since we already billed 99385?
SuperCoder Answered Thu 18th of July, 2019 09:53:44 AM

Hi Tracy,

We bill CPT 99385 (Preventive-New Age 18-39), and pap smear is included in this code. 

However, when patient comes for just pap smear with no medical condition, we will simply bill lowest E/M code. Pap smear is not separately paid. Hope it helps.


Do not report Q0091 for obtaining a diagnostic pap smear performed due to illness, disease or a symptom, because it refers to collection of a screening Pap smear. Also, Q0091 is a HCPCS code developed by Medicare for Medicare patients.

Tracy Posted Thu 18th of July, 2019 10:07:13 AM
That was my thinking. Thank you!
SuperCoder Answered Fri 19th of July, 2019 00:30:11 AM

Thank you, happy to help.

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