billing g0101, q0091 (pap smear) cpt code with covered DX

DIAGNOSTIC CODING FOR THE COLLECTION OF PAP SMEAR AND SCREENING PELVIC EXAM

Both the collection of the screening Pap smear specimen (Q0091) and screening pelvic exam (G0101) are reported with one of the following diagnosis codes:

• V72.31 – routine gynecological exam (reported when provider performs a full gyn examination)
• V76.2 - Special screening for malignant neoplasms, cervix (patient has a cervix)
• V76.47 - Special screening for malignant neoplasms, vagina (patient does not have a cervix)
• V76.49 - Special screening for malignant neoplasms, other sites
• V15.89 - Other specified personal history presenting hazards to health. (patient is considered high risk according to Medicare’s criteria)

Collection of a diagnostic Pap smear (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service and is not reported or reimbursed separately.

Often, both the G0101 and Q0091 are provided during the same visit. An example follows.

Example 1: Collection of a screening Pap smear (Q0091) reported with the screening pelvic examination (G0101):

Bill to:	HCPCS Codes	ICD-9 Codes	Charge
Medicare	G0101-GA	V76.2, V76.47, V76.49, or V15.89	$34.60
	Q0091-GA	V76.2, V76.47, V76.49, or V15.89	$40.00
Patient	N/A	N/A	$0.00
Total amount billed			$74.60

The assumption is that the physician in this example provided only Medicare covered services with no additional preventive care.

The GA modifier indicates that an ABN has been signed. Note that the charges listed in the example above are Medicare allowable amounts but do not include the geographical adjustment factor.
The patient is not initially billed for either of these services since Medicare covers them. Once Medicare has processed the claim, the physician bills the patient for her portion (20% of the Medicare approved amount).