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Question: I was hoping to get some clarification on the Pap smear code Q0091. I have not been using it, as when I was trained I was told it was a lab fee and the insurance companies don’t pay for it. My manager is trying to run a report of how many Pap smears we do and asked what we use to code it. I think the only code would be Q0091, but I haven't been entering it. Should I bill for all Paps, some Paps, or Paps for only some payers?

Virginia Subscriber

Answer: Yes, you should bill the code for all Paps. Code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) is not a lab code, but the code for professional services incurred in obtaining, preparing, and sending the Pap specimen to the lab.

But the hitch is that that code is usually only covered by Medicare (and sometimes Medicare also wants it billed). Private insurance does not usually cover this code, so if you bill them, you will be dealing with a denial each time. You could just enter the code with a 0 charge in those cases, so you can keep easily tracked information.

In some cases, commercial insurance might reimburse 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory) for handling of the Pap specimen, but very infrequently.

There is no other code that will indicate the physician performed a Pap on the patient unless you have a way to capture the lab code for a Pap for ordered tests.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor