Re: ASC-US
From: Rafael Haciski (haciski@earthlink.net)
Sat Sep 1 20:43:22 2007
Pick your battles wisely - this is not a hill worth dying on.
I would have explained to her that it is not medically necessary, and
if she persisted, told her that the insurance may not pay for it, and
that she may have to foot the bill. That usually stops all but the
most intense, and then I do it. It's a free country.
And in reality it is not the time interval that is important but the
repeat look at the cells - PAP smear has a high "miss" rate, and the
repeat PAP is what reduces that "miss" rate. Whether it is done a 3
months, or 4 months, or 6 is immaterial.
I usually do follow up PAPs (for ASCUS, +HPV, L-SILs etc following
colpo confirmation) q 3 months for a total of 4 - never had insurance
problems.
--
Rafael Haciski MD FACOG
Anchor Health Centers GYN
800 Goodlette Rd #360
239-643-8780 office
239-571-0292 cell
Naples, FL.
On Sep 1, 2007, at 8:47 PM, 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
> And this affect me, how?
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Garry E.
> Siegel, M.D.
> Sent: Friday, August 31, 2007 9:41 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Gyn: ASC-US
>
> 16 YO P0000 seen by CNM for annual in April, and the pap is ASC-US,
> reflexed
> to HR HPV positive.
>
> Cancelled appointments, multiple calls--doesn't come in for follow-up.
>
