G2 Compliance Corner

Should we charge for an unsatisfactory Pap smear since we had to do the test to determine it was unsatisfactory? If we do charge, would we get paid? This is a frequently asked question in one form or another, so it is valuable to go over it again. If the payer is Medicare or Medicaid, the government considers a test not medically necessary if it does not produce a clinically useful result that a physician or practitioner can use in the treatment or monitoring of a beneficiary. A laboratory should not charge a government payer for an unsatisfactory Pap, even though the work was done. If you do charge for the test, it is likely that contractors will pay for it because they do not receive test results, only Current Procedural Terminology (CPT) codes and International Classification of Diseases, Ninth Revision (ICD-9) codes. Unless the Medicare system has edits in place to deny claims based on an applicable CPT or ICD-9 code, the test would be paid. It would require a post-payment review or some other kind of audit or review to find out that the test was unsatisfactory. A laboratory may also find itself the subject of a whistleblower […]