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For Pap Smears at Annual Physicals, Medicare

Does Its Own Thing


By Susan Dooley

For decades, Pap smears have been physicians best tools to screen for cervical and vaginal cancer, and
Medicares benefits include this very test, as well as pelvic and clinical breast examination. But though
Medicare reimburses for these screening examinations as Medicare benefits, it does not normally
reimburse CPT preventive screening codes such as 99396 (Periodic comprehensive preventive medicine
reevaluation and management of an individual including an age and gender appropriate history,

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of


laboratory/diagnostic procedures, established patient; 40-64 years).
But never fear HCPCS level II codes are here! No, seriously, CMS created separate HCPCS Q and G
codes to cover these benefits. For that reason, when your providers perform screening Papanicolaou
smears or cervical or vaginal screenings, you should report the following:

Q0091, Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or


vaginal smear to laboratory
G0101, Cervical or vaginal cancer screening; pelvic and clinical breast examination.

Use Q0091 to report to Medicare a screening Papanicolaou smear when your provider obtains it,
prepares it, and sends it to the lab. Use G0101 to report to Medicare that a cervical or vaginal
cancerscreening and pelvic and clinical breast examination has been performed.
Note that these tests are covered once every 24 months for all women Medicare beneficiaries and once
every 12 months for women at high risk for cervical or vaginal cancer. If women Medicare beneficiaries
are of childbearing age and have had an abnormal Pap test in the preceding 36 months, they too are
eligible for these screening tests every 12 months.

Dont Forget the Diagnosis Code!


Of course youll need to include the appropriate ICD-10-CM code with your claim for these HCPCS codes.
For patients who are at a low risk level for cervical or vaginal cancer, report the appropriate code from
the following choices:

Z01.411, Encounter for gynecological examination (general) (routine) with abnormal findings
Z01.419, Encounter for gynecological examination (general) (routine) without abnormal findings
Z12.4, Encounter for screening for malignant neoplasm, cervix
Z12.72, Encounter for screening for malignant neoplasm, vagina
Z12.79, Encounter for screening for malignant neoplasm, other genitourinary organs
Z12.89, Encounter for screening for malignant neoplasm, other sites.

For patients at high risk, youll choose from among these diagnosis codes:

Z72.51, High-risk heterosexual behavior


Z72.52, High-risk homosexual behavior
Z72.53, High-risk bisexual behavior
Z77.22, Contact with and (suspected) exposure to environmental tobacco smoke
Z77.9, Other contact with and (suspected) exposures hazardous to health
Z91.89, Other specified personal risk factors, not otherwise classified
Z92.89, Personal history of other medical treatment.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Got Pap Tips?


Got tips for success in reporting screening Papanicolaou smears? Let us know!

Stay Compliant and Fast With Fast Coder!


Need to keep your Medicare rules straight? When you subscribe to SuperCoders Fast Coder, you can
check fees, crosswalk between ICD-9-CM and ICD-10-CM codes, and check out the diagnosis and CPT
codes submitted most frequently together for Medicare and private payer claims. Best of all, you can
search across ICD-10, ICD-9, CPT, and HCPCS codes and you can stay compliant with CCI, NCDs, and
LCDs. Contact us for your trial access today!

Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813


The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com