Physicians Practice Questions & Answers : Pelvic exam and Pap smear payment

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Questions & Answers

Pelvic exam and Pap smear payment (posted 7/1/08)

Q: I have a question concerning billing for pelvic exams and pap smears. I am told they are nonbillable services and that the physicians must just increase his E&M charge to cover it.

A: Medicare covers both, with certain limitations. Frequency allowed is determined by risk. To bill Medicare, you need to use a screening diagnosis code, usually v76.2 or v76.47. The procedure is billed with HCPCS codes, described in the chart below.

Usually, other payers do consider the Pap to be part of a preventive exam — and so also part of the E&M code. There are some payers in the country that have determined they will pay separately for the collection of the Pap smear when performed at the time of a routine preventive exam. Usually they provide written instructions to bill the Q0091 as an additional code. If the payer has issued that instruction, report the code.

Additional Resources

View more questions and answers from the July/August 2008 issue

View more questions and answers related to Billing & Collections

View more questions and answers related to Coding

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