Coding Question of the Month

November 2018: Choosing the Correct Diagnosis Code for Medicare Preventive Screening Services

The screening pelvic and clinical breast exams, as well as the collection of the screening Pap smear specimen for Medicare beneficiaries, are reported using the following HCPCS codes:

  • G0101    Screening pelvic exam and clinical breast check
  • Q0091    Collection of the screening Pap smear specimen

Note: Medicare considers the performance of diagnostic pap smears as part of the evaluation and management service. There is no separate code available to report for diagnostic pap smears.

Generally, the most appropriate diagnosis for each of these services are codes from ICD-10-CM subcategory Z01.41-:

  • Z01.411   Encounter for gynecological examination (general) (routine) with abnormal findings, OR
  • Z01.419   Encounter for gynecological examination (general) (routine) without abnormal findings

*View ACOG coding resources on reporting Z01.411 and Z01.419.

Z01.411 and Z01.419 are reported if the patient has not undergone a hysterectomy. When reporting services for patients in the absence of the uterus, the following codes should be considered:

  • Z12.72     Encounter for screening for malignant neoplasm of vagina
  • Z12.79     Encounter for screening for malignant neoplasm of other genitourinary organs, OR
  • Z12.89     Encounter for screening for malignant neoplasm of other sites as appropriate

For codes Z12.72, Z12.79, and Z12.89, use an additional code to identify any family history of malignant neoplasm (Z80.-) or acquired absence of uterus (Z90.71-) as appropriate.

Per CMS, other diagnosis codes that are appropriate when reporting HCPCS code G0101 are:

  • Z12.4       Encounter for screening for malignant neoplasm of cervix
  • Z72.51     High risk heterosexual behavior
  • Z72.52     High risk homosexual behavior
  • Z72.53     High risk bisexual behavior
  • Z72.89     Other problems related to lifestyle
  • Z77.22     Contact with and (suspected) exposure to environmental tobacco smoke
  • Z77.9       Other contact with and (suspected) exposures hazardous to health
  • Z91.89     Other specified personal risk factors, nor elsewhere classified

More specific information can be found in the Medicare Claims Processing Manual. Please note that the charts on pages 103-104 of the Manual include both ICD-9-CM and ICD-10-CM codes. Be sure to report the appropriate ICD-10-CM code instead of an ICD-9-CM code.

The Pap smear screening test (Q0091) may be reported with any of the following diagnoses, in addition to the diagnoses listed above:

  • Z77.21    Contact with and (suspected) exposure to potentially hazardous body fluids
  • Z77.29    Contact with and (suspected) exposure to other hazardous substances
  • Z92.89    Personal history of other medical treatment
 

Contact:

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Donna Tyler
Director, Coding
dtyler@acog.org

Joyce Kilgore
Facility Coding Education Specialist
JKilgore@acog.org

Miroslava Rudneva
Coding Education Specialist
MRudneva@acog.org

Tatyana Mallory
Facility Coding Education Specialist
TMallory@acog.org

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