Medical Billing for High Risk Pap

The medical billing staff members in the OB-GYN office have their work cut out for them. There are so many rules and regulations about procedures specific to this specialty. The Pap smear is one area that can get sticky. Knowing how to correctly do medical billing for a high risk pap smear is an important skill.

When you are doing medical billing for a Medicare patient, a high risk pap smear must meet to criteria. First, the patient must have over five sexual partners, or have had sex before she turned 16. Only in these instances can you do medical billing for a high risk, screening pap smear.

Many medical billing staff members may think that it is appropriate to claim a high risk pap for a patient with previous cervical or uterine cancer. There are two problems with this scenario. First of all, Medicare requires you bill for an evaluation and management when doing medical billing for a prior cancer pap smear. Then, this becomes a catch 22. Once you use the evaluation and management medical billing code, the pap smear is included in that code and not reimbursed separately.

This means, the only time you can really get separate reimbursement for a high risk pap smear is if the patient had sex before 16 or had more than five partners. This medical billing rule should not alarm your staff. This is not a change. The medical billing rules for pap smears have always been this way. It is your job to train your staff members the correct way to code claims and submit medical billing papers. Accurate information is imperative to your success as a practice. High risk pap smears may be difficult to code, but your practice will be at high risk for failure if your medical billing is not correct.

View all Articles by: Melissa Clark, CCS-P