Screening Pap Tests - CPT G0123, G0143 &G0124 ,P3000 Q0091


The screening Pap test (Pap smear) covered by Medicare is a laboratory test that consists of a routine  exfoliative cytology test (Papanicolaou test) provided for the purpose of early detection of cervical cancer.

It includes collection of a sample of cervical cells and a physician’s interpretation of the test.

A cervical screening detects significant abnormal cell changes that may arise before cancer develops; therefore, if diagnosed and treated early, any abnormal cell changes that may occur over time can be reduced or prevented. The cervical screening benefit covered by Medicare can aid in reducing illness and
death associated with abnormal cell changes that may lead to cervical cancer.

Covered once every 12 months:

Medicare provides coverage of a screening Pap test annually (i.e., at least 11 months have passed following the month in which the last Medicare-covered Pap test was performed) for female beneficiaries who meet one of the following criteria:

1.  There is evidence (on the basis of her medical history or other findings) that the woman is of childbearing age and has had an examination that indicated the presence of cervical or vaginal cancer or other abnormalities during any of the preceding 3 years, or

2. There is evidence that the woman is in one of the high risk categories (previously identified) for developing cervical or vaginal cancer, or has other specified personal history presenting hazards to health.

Coding and Diagnosis Information

G0123
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision

G0143
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision

G0144
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system under physician supervision

G0145
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision

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
Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician

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

Diagnosis Requirements

When a Medicare provider files a claim for a screening Pap test, one of the screening (“V”) diagnosis codes listed in Tables 4 and 5 must be used. Code selection depends on whether the beneficiary is classified as low risk or high risk. The provider must report this diagnosis code, along with other applicable diagnosis codes. Failure to report the V72.31, V76.2, V76.47, V76.49, or V15.89 diagnosis code will result in denial of
the claim.

V72.31
Routine Gynecological Examination
NOTE: This diagnosis should only be used when the provider performs a full gynecological examination.
V76.2
Special screening for malignant neoplasms, cervix
V76.47
Special screening for malignant neoplasms, vagina Screening

Reasons for Claim Denial

Following are examples of situations when Medicare may deny coverage of screening Pap tests:

* The beneficiary who is not at high risk has received a covered screening Pap test within the past two years.
* The beneficiary who is at high risk has received a covered screening Pap test during the past year


Misuse of column two code with column one code

For example, the professional component CPT code 88141 describes the  physician interpretation of a diagnostic cervical or vaginal cytopathology specimen and may be reported with technical component CPT codes for diagnostic cervical or vaginal cytopathology such as CPT codes 88142-88154, 88164-88167, and 88174-88175. CPT code 88141 should not be reported with HCPCS codes for screening cervical or vaginal cytopathology such as G0143. It is a misuse of CPT code 88141 to report a physician interpretation of a screening cervical or vaginal cytopathology specimen reported as HCPCS code G0143.


CODE RULE CODE

G0143  Incidental to   88141


Papanicolaou Smear

Description: The following policy addresses Blue Cross and Blue Shield of Minnesota’s (Blue Cross) billing and coverage of Papanicolaou (Pap) tests.

Definitions: A Pap test is a smear of vaginal or cervical cells obtained for cytological study.

There are several types of methods and systems of testing the smear. Codes 88142-88154, 88164-88167, 88174-88175, P3000, P3001, G0123-G0124, and G0141, G0143-G0148 are for cytopathology screening of cervical or vaginal smears.

Policy: The procedure codes, diagnosis codes, specimen collection codes and handling fee that apply to Papanicolaou smears are detailed below.

Procedure Codes

Codes 88142-88154, 88164-88167, 88174-88175, P3000, P3001, G0123-G0124, and G0141, G0143-G0148 are for cytopathology
screening of cervical or vaginal smears. Submit the appropriate code to reflect the service provided.

Procedure code 88141 and 88155 are used to report physician interpretation of a cervical or vaginal specimen and should be listed in addition to the screening code chosen when the additional services are provided.

Diagnosis Codes

Routine cervical Papanicolaou smears should be reported with appropriate ICD-10-CM diagnosis codes:

Use this code… In this situation… Z01.42 As part of a general gynecological examination 

Coding: The following codes are included below for informational purposes only, and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement.

CPT/HCPCS Modifier: 90 ICD-Diagnosis: Z01.42, Z12.4 (ICD-10); V72.32, V76.2 (ICD-9) ICD-Procedure: N/A
HCPCS: 88141-88155, 88164-88167, 88174-88175, 99000, P3000,

P3001, G0123-G0124, G0141, G0143-G0148, Q0091


1 comment:

Darras Law said...

Yes I have read the statement Appeal Insurance Denial.It is good.

Medical Billing Popular Articles