Top Five Most Common Pap Smear Coding Errors
Changes over the years in coding guidelines have affected how we should code and bill pathology specimens. Not all offices may be aware of these changes or may interpret their application differently. The InCyte Pathology coding experts will attempt to provide clarity for the Top 5 Most Common Pap Smear Coding Errors we see in our practice.
#1) Diagnostic vs. Screening. To help you determine if a Pap smear was performed for diagnostic or screening purposes, here are a few tips. A diagnostic code should be used where there are any signs or symptoms of disease.
A Pap smear is considered diagnostic if it meets any of the following criteria:
The patient has:
- been treated or is being treated for cancer of the cervix, uterus or vagina
- follow up on a previous abnormal Pap smear
- abnormalities of the vagina, cervix, uterus, ovaries or adnexa are found on exam
- signs or symptoms that might reasonably be related to a gynecological disorder.
Some common diagnostic Pap codes include: 795.00-795.09, 622.10-622.12, V10.40-V10.44, 626.0-626-9, V67.01.
Screening Pap smears are done in the absence of sign, symptoms or history. They may fall into two risk categories: no-risk and high-risk. A no risk patient is eligible for routine screening once every two years (Medicare) or every year (other payers). A Medicare high-risk patient may receive a Pap smear on an annual basis.
High-risk factors include:
- Early onset of sexual activity
- Multiple sex partners
- History of sexually transmitted disease
- < 3 negative Pap Smears in 7 years
- DES exposure during pregnancy
No-risk = Screening ICD-9 code
High-risk = V15.89 ICD9 code
The criteria for Screening Pap smears may include one of the following conditions:
- Physician recommends the procedure
- Patient is of childbearing age
- No Pap smear in the past 3 years
- High risk factors for cervical or vaginal cancer
#2) Screening Pap smears have several codes. You understand the difference between diagnostic and screening, but did you know there are multiple codes for Screening Paps?
- V72.31 = routine gyn exam (if ob/gyn performs breast exam etc.) includes cervical pap screening must add codes for HPV, GC/CT and vaginal pap screenings
- V76.2 = cervical pap screening only
- V76.47 = vaginal pap screening only (hysterectomy for non-malignant reasons)
- V76.49 = Pap screening other sites (hysterectomy for malignant conditions)
Example 1: A women goes to the doctor for her annual exam. The doctor performs a breast exam, cervical pap, etc. The pap is sent to the lab with a request for Pap, HPV if result is ASCUS, GC/CT testing.
Codes should be V72.31, V73.98, V74.5
Example 2: A women goes to the doctor for her annual exam after having had a hysterectomy 10 years ago for malignancy. The doctor performs a breast exam, pap, etc. The pap is sent to the lab with a request for a pap.
Codes should be V72.31, V76.49
Example 3: In December 2011, a women goes to the doctor for her annual exam. She had an abnormal pap (795.03) in November 2010. She had a follow-up pap in June 2011 which was normal. The doctor is still following her regarding the abnormal result in Nov 2010. Even though the women goes to the doctor for her wellness exam, the Pap portion of the exam is not routine as it is still being followed.
Codes should be 795.03
#3) Pregnancy – If a patient presents for a Pap test due to pregnancy, pregnancy codes should be submitted. If a patient presents for a Pap test following delivery during a post-partum check, post-partum codes should be used.
- Pregnancy = V22.0 or V22.1 if normal supervision
- Pregnancy = V23.xx if high-risk pregnancy
- Pregnancy = V22.2 if pregnancy is incidental to the visit and not the reason for the visit (use as secondary code only)
- Postpartum = V24.2
#4) Invalid ICD-9 codes – Avoid using codes that are outdated such as V72.6 or codes that require additional digits such as V72.3 (V72.31 or V72.32)
- 622.1 (could be 622.10, 622.11, 622.12)
- 795. (could be 795.00, 795.01, 795.02, 795.03, 795.04, 795.06, 795.09, 795.10, 795.11, etc)
- 599.7 (could be 599.70, 599.71, 599.72)
#5) All cases need either a dx code (ICD-9) or notes easily converted to ICD-9 code(s).
- Paps must have ICD-9 as verbiage most likely won’t narrow code selection enough
- All other may have either ICD-9 codes or verbiage
Verbiage for Rule Out (R/O) cannot be coded for billing purposes. Signs or symptoms must be clearly noted.
Example: R/O Crohn’s
Should be: R/O Crohn’s, RLQ abdominal pain, diarrhea
There is a lot to know about the appropriate method of coding. In this article, we only covered the basics on Pap smear coding.