Medical practices often ask what codes to use in order to bill for a pap smear provided during a preventive medicine service or other E/M service. The only CPT codes specifically for pap smears are for use by a pathologist, for the interpretation of the cytology specimen. CPT codes in the lab section, 88000 series, should not be reported by the office physician who collects the pap smear. Those codes are used by the pathologist who provides the interpretation of the pap smear.
So, what does a gynecologist or primary care practitioner report for doing a pap smear at a visit? The answer depends on the type of service.
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory (Obtaining screen pap smear )
If a patient presents with a condition or complaint, and the practitioner does a pelvic exam and collects a pap smear, bill an E/M service only. Select the level of E/M service based on the key components or time, if counseling dominates the visit. Do not report Q0091 for obtaining a diagnostic pap smear performed due to illness, disease or a symptom.
If the patient presents for a preventive medicine service, the pelvic exam is part of the age and gender appropriate physical exam, as described by CPT codes in the 99381—99397 series of codes. However, for a screening pap, the HCPCS code for obtaining the screening pap smear, Q0091 may be used. Although this is a HCPCS code developed by Medicare for Medicare patients, many commercial payers recognize the code.
Cervical or vaginal cancer screening; pelvic and clinical breast examination ( Ca screen; pelvic/breast exam )
Medicare doesn’t pay for routine services, but does pay for a cervical/vaginal cancer screening with a breast exam. (Medicare pays for wellness visits, not discussed here.) A Medicare patient may have a pelvic and clinical breast exam performed alone, at the time of a problem oriented visit or on the day of a wellness visit. There is a HCPCS code for this, G0101. Do not bill this code in addition to a preventive service reported with CPT codes 99381—99397. Those codes include an age and gender appropriate physical exam and if needed, the pelvic and breast exam is part of that service. Most commercial payers do not recognize G0101. G0101 requires a breast exam and a total of 7 of these exam elements:
- Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge
- Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses
- External genitalia
- Urethral meatus
- Anus and perineum
There is no code for performing the breast exam alone on a Medicare patient who does not need the remainder of the screening exam elements.
If using CPT preventive medicine services, and also performing a screening pap smear report a code in 99381-99397 series and Q0091.
If using E/M codes for a symptom or condition and practitioner also obtains a pap smear report only the E/M service. Do not report Q0091 because it is for obtaining a screening test.
Use G0101 and Q0091 for Medicare patients receiving a screening pelvic and breast exam and having a screening pap smear. There are frequency limits for this service.