Coding Women’s Preventive Services
Coding for women?s preventive services requires an understanding not only of the procedures but also the related codes and coverage requirements as well.
Cervical Cancer Screening
Several CPT(R) code families describe Pap tests, depending on how tissue samples are prepared for examination.
During a conventional Pap smear the collected sample is smeared directly onto a microscope slide for examination.
Final code selection depends on how the results are screened manually with:
? Physician supervision,
? Manually with computer-assisted rescreening under physician supervision or
? Manual screening and rescreening under physician supervision
The Bethesda method CPT(R) 88164-88167 evaluates specimen adequacy and provides specific categories for abnormal findings. As with a conventional Pap smear, the final code selection will depend upon the method of screening; when applicable, the method of rescreening.
For the liquid preservative method, such as Thin Prep(R) CPT(R) 88174-88175 the collected sample is preserved in liquid rather than smeared directly onto a slide. This helps to prevent drying and clumping of cells and improves diagnosis accuracy.
Final code selection depends on whether the screening is:
? Fully automated, or
? Automated with manual rescreening under physician supervision
Breast Cancer Screening
There is no separate code to report a clinical breast exam; instead, the service would count as part of any preventive or E/M service provided.
Code 77057 Screening mammography, bilateral (2-view film study of each breast) describes a bilateral screening mammogram. 77052 Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography should be listed separately in addition to code for primary procedure if a computer is used to review the mammography results.
Ovarian Cancer Screening
Report a limited ultrasound assessment for ovarian screening using 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles).
Elements of a complete pelvic ultrasound (76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete) go beyond examination of the ovaries to include medically necessary examination with a description and measurement of the uterus and adnexal structures, endometrium, bladder, and of pelvic pathology as per the American Urological Society. Do not apply 76856 for a limited ovarian screening.
Osteoporosis Screening
There are several screening tests for osteoporosis. The most common is dual energy X-ray absorptiometry (DEXA or DXA), reported with:
? 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) or
? 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)
Medicare coverage for women?s screening exams may vary, depending on whether the Medicare beneficiary qualifies as high risk.
For example, Medicare Part B covers a screening Pap test for all asymptomatic female beneficiaries every 24 months. Medicare will cover Pap screening annually for beneficiaries of childbearing age who have had an abnormal Pap test within the past three years, or beneficiaries at high risk for cervical or vaginal cancer. High-risk categories include:
? Early onset of sexual activity (under 16 years of age);
? Multiple sexual partners (five or more in a lifetime);
? History of a sexually transmitted infection, including human immunodeficiency virus (HIV) infection;
? Fewer than three negative Pap tests or no Pap tests within the previous seven years; and
? Diethylstilbestrol (DES)-exposed daughters of women who took DES
CMS designates nearly a dozen HCPCS Level II codes to describe various screening Pap tests, including physician supervision and laboratory specimens.
Medicare covers a screening pelvic examination every two years for most female beneficiaries. If the patient meets Medicare?s criteria for high risk (similar to those for Pap smear), the examination is reimbursed every year.
Medicare Part B covers screening mammogram annually for beneficiaries aged 40 and older. CMS accepts the standard CPT(R) codes for screening mammography, but also designates HCPCS Level II code G0202 Screening mammography, producing direct digital image, bilateral, all views for bilateral screenings producing direct 2-D digital images.