annual exam used with male provider and patient returns to see female provider for pap

What code would the female provider use when seeing a patient for a pap only? The patient had her annual preventative visit with her regular PCP which happens to be male. She preferred to return a week later to see the female provider to have her pap smear done. How does the female provider bill for this? Any suggestions?

Thank you,


  • Why would it make any difference if the provider was male or female as far as billing?? Pap by itself would be Q0091. We use that for Medicare and other payers as well.

    Member American Medical Billing Association
    Member American Academy of Professional Coders
    (931) 879-9854

  • Look at G0101 and Q0091 to see if that is what your doctor is doing.

    A screening pelvic examination (HCPCS code G0101) should include documentation of at least seven of the following eleven elements:
    1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge
    2. Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses
    3. External genitalia (for example, general appearance, hair distribution, or lesions)
    4. Urethral meatus (for example, size, location, lesions, or prolapse)
    5. Urethra (for example, masses, tenderness, or scarring)
    6. Bladder (for example, fullness, masses, or tenderness)
    7. Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele)
    8. Cervix (for example, general appearance, lesions or discharge)
    9. Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support)
    10. Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity) and/or
    11. Anus and perineum HCPCS code G0101 includes only the above examination elements. It does not include the many other services normally included in a comprehensive preventive visit.

    Diagnostic Coding for the Collection of a Pap smear Specimen and the Screening Pelvic Exam Both the collection of the screening Pap smear specimen (Q0091) and screening pelvic exam (G0101) may be limited by an LCD in your locality so you will want to check with the carrier website to be sure.

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  • We have this issues ourselves. In the past we billed a CPE for the services provided by the male, and an e and m for the services provided by the female. Once we reviewed the medical records, we realized this was incorrect billing and we stopped. We now only charge for the CPE as we figure the gyn exam is a component of the previously billed well service.


    Beth Aldridge, CPC
    Coding Manager

    Northern California Medical Associates, Inc
    Phone: (707) 573-6145
    Fax: (707) 573-6932

  • Thank you everybody, I just wasn't sure if all payers recognized the Q0091 code. We were having the same issue as Beth mentioned. I really appreciate all of your input.
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