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You
can look forward to easier claim preparation for Pap smears
now that The Centers for Medicare and Medicaid Services
has fixed some problems with coding for routine Paps.
Problem:
Some claims for preparation and conveyance of Pap smears
were "paying incorrectly" when providers performed
them outside of the frequency edits that Medicare laid down,
CMS says in Transmittal 440, issued Jan. 21.
Solution:
CMS is adding a new edit to the Common Working File, which
carriers use to process claims, that will allow providers
to bill screening Pap smear code Q0091 every two years for
low-risk beneficiaries and every year for high-risk beneficiaries.
The new edit will prevent you from obtaining payment for
Q0091 if you accidentally perform a Pap smear more often
than every two years for a normal patient. In cases where
you obtain an unsatisfactory Pap smear specimen that a lab
can't interpret, use modifier -76 (Repeat procedure by same
physician) to bypass the frequency edits, CMS advises.
New
V code: Another change announced in Transmittal 440
has providers cheering. CMS says it's adding a new diagnosis
code, V72.31 (Routine gynecological examination), to the
list of diagnosis codes covered for screening Pap smears.
You should append this code only when the provider performs
a full gynecological examination, CMS instructs.
The
addition of V72.31 "actually makes it possible to code
more accurately," says Jo Anne Steigerwald, senior
consultant with the Wellington Group.
The
change allows coders to clarify that the Pap smear was part
of an overall gynecological examination, says coder Becky
Swank with the Wichita Clinic in Wichita, KS. Medicare already
covered other screening V-codes, such as V76.2, V76.47 or
V76.49 with screening Pap smears, and V15.89 for high-risk
screenings.
Coding
before the addition of V72.31 "was kind of confusing
for us" because a provider would perform a breast and
pelvic exam along with a Pap smear, but coders were unable
to clarify that the Pap was part of a comprehensive gynecological
exam, Swank says. "This makes much more sense."
But
Medicare still won't cover diagnostic Pap smears with diagnosis
code V72.32 (Encounter for Papanicolaou cervical smear to
confirm findings of recent normal smear following initial
abnormal smear), Swank says. This code would allow providers
to bill accurately for Pap smears when a patient has had
an abnormal Pap smear followed by a normal Pap smear, and
the provider wants to double-check the normal finding.
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