• 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

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.