How to properly code for a Pap smear

Finding the correct code in your CPT book for administering a Pap smear isn’t easy. What comes up most often are codes 88141-88175, which are actually meant for pathologists examining a specimen. A search in your electronic health record will often find HCPCS code Q0091, “Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory.” Here’s when to use (and when not to use) that code.

The patient preventive medicine services codes 99381-99397 include an age- and gender-appropriate physical exam. According to CPT Assistant, performing a pelvic and breast exam, as well as obtaining a screening Pap smear, are all part of the comprehensive preventive service and should not be reported separately.¹ Some private payers, however, will pay for obtaining a screening Pap smear using code Q0091 on the day of a preventive medicine service, so it is worth checking with them.

If a patient presents for a symptom or complaint that requires a Pap smear for diagnosis, the physical exam and obtaining the Pap smear are part of the E/M service and are not separately reportable. Additionally, you would not use Q0091 in this instance because that is a code for obtaining a screening Pap smear, not a diagnostic one.

For Medicare patients who still need a Pap smear, use Q0091 when a screening Pap smear is obtained even if this service is provided in addition to a wellness visit. For a screening clinical breast and pelvic exam, you can bill Medicare patients using code G0101, “Cervical or vaginal cancer screening; pelvic and clinical breast examination.” Note that this code has frequency limitations and specific diagnosis requirements.

Bottom line: 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.

1. CPT Assistant. August 2005;15(8):13-15.

– Betsy Nicoletti, a Massachusetts-based coding and billing consultant

Posted on Feb 27, 2019 by Betsy Nicoletti