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Re: ASC-US From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca) Sun Sep 2 06:21:56 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: FRANCES WREN: "Re: ASC-US" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: 16 yr olds and abnormal Paps" At Sat, 1 Sep 2007, R. Berg wrote: > >Unfortunately, today, I had just the reverse problem. > >5/07 pap, ASCUS, HR HPV *negative* > >Pt comes in 3 months later, c/o vague pelvic pain x 2 weeks. Exam >completely unremarkable. She then asks for a repeat pap, based on the >letter I sent her, suggesting that her slightly abnormal pap, although not >concerning for dysplasia, should be followed up in 6 months. > >I declined to perform one, suggesting to her that a repeat in *6* months is >probably overdoing it. > >She left the office (this is 4 days ago). Today, she calls me, *irate*, and >tells me that it is her "legal right" and that it is my "legal obligation" >to perform a repeat pap smear; furthermore, since she has celiac disease and >that this condition is associated with lymphoma, and that her mother had an >ovary removed for a nonmalignant condition she *needs* a repeat pap smear >now, given that it is only 3 months less than the time I suggested for her >to repeat the smear (I guess it's not really a "smear" anymore, more of a >"stir" or "swish." Pap Swish doesn't really sound as clinical, I suppose). >Again, I declined. She then informed me that her only recourse would be to >contact her insurance company to demand that I repeat it. I told her that >she can do what she feels necessary, but that her insurance company would >likely agree with me, and, in any event, no matter what they said, I would >not be repeating the test, as I do not feel that it is medically indicated. > >So should I have: > >1) repeated the smear, coding 795.01, ASC-US on pap, just because she wanted >one, or > >2) repeated the smear, coding 300.02, generalized anxiety disorder or 300.7, >hypochondriasis, or > >3) stuck to (and keep sticking to) my guns? > >____________________________________________________________________________ >Robert E. Berg, MD >____________________________________________________________________________ > >-- >____________________________________________________________________________ No brainer for me, I would repeat the PAP and not even bill my fee for >____________________________________________________________________________ it; then I would let her argue with the insurance company about the lab fee's. I can't see why she should not have a repeat PAP if she is willing to pay for it. -- Take care, John Next message: FRANCES WREN: "Re: ASC-US" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: 16 yr olds and abnormal Paps"

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