Family medicine and OB/GYNs practices regularly have women come in for their pap and pelvic exam. A Pap test is a simple and quick screening test conducted to obtain a smear of vaginal or cervical cells for cytological study. The human papillomavirus (HPV) test and the Pap test examine cells from a woman’s cervix. The Pap test looks at the cells to see if they are cancerous. In the HPV test, the cells are analyzed for HPV infection. Previously, the USPSTF had recommended use of both the HPV test and the Pap test every five years, for women in the age range 30 to 65. According to the 2018 USPSTF guidelines:
- Women in the age range 30 to 65 can be screened for cervical cancer with a test for “high risk” strains of the HPV every five years, without undergoing a simultaneous Pap test.
- Women in the age range 30 to 65 can be screened for cervical cancer with the Pap test alone every three years.
A Pap test is done in a doctor’s office, while the HPV test can be done at home. Physicians need to know which codes to report for administering a pap smear at a visit as well as the payer reimbursement guidelines for this service. In fact, billing for a pap smear provided during a preventive medicine service or other E/M service is much easier with help from an experienced medical billing company.
Coding for a Pap Smear – Points to Note
The CPT codes for cytopathology screening of cervical or vaginal smears are: 88141-88155, 88164-88167, 88174-88175, P3000, P3001, G0123-G0124, and G0141, G0143-G0148 are.
The code submitted should reflect the service provided.
- A recent report from the American Academy of Family Physicians (AAFP) points out that codes 88141-88175 are meant for pathologists examining a specimen.
- 88141 Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician (to be listed separately in addition to code for technical service)
- 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thinlayer preparation; manual screening under physician supervision)
- 88143 With manual screening and rescreening under physician supervision
- 88147 Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision
- 88148 Screening by automated system with manual rescreening under physician supervision
- 88155 Cytopathology, slides, cervical or vaginal definitive hormonal evaluation (e.g. maturation index, karyopyknotic index, estrogenic index). List separately in addition to code(s) or other technical and interpretive services.
- 88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision
- 88165 With manual screening and rescreening under physician supervision
- 88174 With manual screen and computer rescreen
- 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
- Medicare-covered Screening Pap Tests: Physicians may perform a screening Pap test and a screening pelvic examination during the same patient encounter. In this case, CMS instructs that both procedure codes should be reported as separate line items on the claim. HCPCS codes should be used to report screening Pap tests, for the physician interpretation of the screening Pap test, and to report when the physician obtains and prepares the specimen, conveys the test, and sends the specimen to a laboratory.
HCPCS Codes for Screening Pap Tests
- G0123 Screening liquid-based Pap, any reporting system
- G0143 Screening liquid-based Pap, any reporting system with manual screening and rescreening, under physician supervision
- G0144 Screening liquid-based Pap, automated (location-guided)
- G0145 Like G0144 but with manual rescreening
- G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
- G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
- P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
HCPCS Codes for Physician’s Interpretation of Screening Pap Tests
- G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
- G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
- P3001 As above requiring interpretation by pathologist
HCPCS Code for Laboratory Specimen of Screening Pap Tests
- Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
- Using HCPCS code Q0091: Q0091 should be used when obtaining a screening Pap smear for a Medicare patient, though private payers may allow it along with a preventive medicine service (AAFP). Here are some points to note with regard to Q0091:
- CPT Assistant guidelines state that a pelvic and breast exam, and a screening Pap smear, are all part of the comprehensive preventive service and should not be reported separately.
- Some private insurers will reimburse for obtaining a screening Pap smear using code Q0091 on the day of a preventive medicine service.
- If a patient has a symptom or complaint that needs a Pap smear for diagnosis, the physical exam and obtaining the Pap smear are included in the E/M service and are not separately reportable. In other words, Q0091 should not be used when the Pap smear is done for diagnostic purposes.
- In the case of Medicare patients who still need a Pap smear, Q0091 should be used when a screening Pap smear is done even if this service is provided in addition to a Wellness Visit.
- For a screening clinical breast and pelvic exam, Medicare patients can be billed using code G0101, “Cervical or vaginal cancer screening; pelvic and clinical breast examination.”
Knowing the codes as well as Medicare and private payer rules is crucial to get reimbursed for administering Pap smears. Partnering with an experienced OB-GYN / family practice medical billing company can ensure accurate reporting of Pap screening.