HOW TO BILL AND CODE FOR
www.outsourcestrategies.com
Healthcare providers need to be aware the codes for the pap smear exam as well as commercial and Medicare billing guidelines for reporting the service. 1-800-670-2809
According to the National Institutes of Health (NIH), over 4,000 women in the U.S. and over 300,000 women worldwide die from cervical cancer each year. Our medical coding outsourcing company had reported on Cervical Cancer Awareness Month which is observed in January to bring more attention to a preventable disease. The papanicolaou test or pap test is a reliable cervical screening method that makes it possible to find and treat cervical cancer in the early stages. The National Cervical Screening Program recommends pap smears as the primary method for screening until there is sufficient evidence indicating the effectiveness of new cervical screening technologies. Healthcare providers, that is, the physician who collects the smear and the pathologist who provides the interpretation for it, need to be aware the codes for the Pap smear exam as well as commercial and Medicare billing guidelines for reporting the service.
CPT and HCPCS codes for Gynecologic Cytology CPT codes are used for diagnostic paps, while HCPCS codes are used for screening Paps. CPT Codes CPT codes in the 88000 series are cytopathology codes and should be reported by the pathologist’s lab. The CPT codes for pap smears are as follows: 88141 - Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician (List separately in addition to code for technical service.) 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and re screening under physician supervision 88147 Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision 88148 Cytopathology smears, cervical or vaginal; screening by automated system with manual re screening under physician supervision 88150 Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
www.outsourcestrategies.com
1-800-670-2809
88152 Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted re screening under physician supervision 88153 Cytopathology, slides, cervical or vaginal; with manual screening and re screening under physician supervision 88154 Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted re screening using cell selection and review under physician supervision 88155 Cytopathology, slides, cervical or vaginal definitive hormonal evaluation (e.g. maturation index, karyopyknotic index, estrogenic index). List separately in addition to code(s) or other technical and interpretive services 88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 88165 With manual screening and rescreening under physician supervision 88174 With manual screen and computer rescreen 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
HCPCS Codes for Screening Pap Smear Tests The following HCPCS codes are used to report screening pap smear tests to Medicare: G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision. G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and re screening by cytotechnologist under physician supervision G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system under physician supervision
www.outsourcestrategies.com
1-800-670-2809
G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual re screening under physician supervision G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual re screening P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
HCPCS Codes for Physician’s Interpretation of Screening Pap Tests G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual re screening, requiring interpretation by physician P3001 Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician
Q0091 -- HCPCS Code for Laboratory Specimen of Screening Pap Tests Q0091 should be reported to Medicare for the collection of screening pap smears for Medicare patients. As this is a Medicare-specific code, it should not be used for commercial plans. Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
HCPCS Code for Screening Pelvic Examinations In the preventive medicine service, the pelvic exam is part of the age and gender appropriate physical exam, as described by CPT codes 99381—99397. The following HCPCS code is used a screening pelvic exam during a preventive medicine service: G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination
www.outsourcestrategies.com
1-800-670-2809
Coding Guidelines Commercial payers and Medicare have specific guidelines for coding pap smear tests:
If an abnormality is encountered or a preexisting problem is addressed in the course of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require the additional work of a problem-oriented E/M service, then the appropriate Office/Outpatient E/M code 99201 – 99215 should also be reported. Modifier -25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service. The appropriate preventive medicine service should also be reported.
G0101 and Q0091 should be used for Medicare patients receiving a screening pelvic and breast exam and having a screening pap smear. Providers should know that there are frequency limits for this service.
HCPCS code Q0091 (screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) - As the collection of a diagnostic pap smear for a Medicare patient (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service, it is not reported or reimbursed separately. However, CMS instructs that if a significant, separately identifiable E&M service is performed to evaluate other medical problems, both the screening pap smear and the E&M service may be reported separately. Modifier 25 should be appended to the E&M CPT code indicating that a significant, separately identifiable E&M service was rendered.
If another specimen is collected in situations where unsatisfactory screening pap smear specimens have been collected and conveyed to clinical laboratories that are unable to interpret the test results, Medicare instructs that this reconveyance should be billed by annotating the claim with HCPCS code Q0091 along with modifier -76 (repeat procedure or service by same physician or other qualified health care professional).
HCPCS code G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) - CMS instructs that G0101 may be reported with evaluation and
www.outsourcestrategies.com
1-800-670-2809
management (E&M) services under certain circumstances. If a Medicare covered reasonable and medically necessary E&M service requires breast and pelvic examination, G0101 should not be additionally reported. However, if the Medicare covered reasonable and medically necessary E&M service and the screening service, G0101, are unrelated to one another, both HCPCS code G0101 and the E&M service may be reported appending modifier 25 to the E&M service CPT code. Use of modifier 25 indicates that the E&M service is significant and separately identifiable from the screening service, G0101. Relying on medical billing outsourcing services is a feasible option to handle the complexities of reporting gynecologic cytology and ensure proper reimbursement.
www.outsourcestrategies.com
1-800-670-2809