Diagnosis on preventive visits

[LGW]

I have seen various threads and reviewed both the ACOG and Medicare web sites but I am still confused about using the V72.31, V76.2 and V76.47. I have two questions:

1. The description in the ICD-9 book for V72.31 says: General GYN exam w or w/o pap cervical smear. Why would you even use the V76.2 or V76.47 with that code, especially since the description for V76.2 is exlcuded from V72.31? Isn't that duplicate info or are you clarifying that a pap actually occured? Do you use V76.47 instead of V76.2 if a pap occured as part of a well woman exam?

2. ACOG states that V76.2 is a pap on a pt w/ a cervix and V76.47 is a pap on a pt w/o a cervix. The ICD-9 description for V76.47 does not distinguish a pap on a pt w/o a cervix, just refers to additional codes V88.01-88.03 and V67.011 for a pt w/o a uterus. So which is it?

[mitchellde]

You do not code V76.2 with a V72.31 that is why it is excluded. However if the physician documents a Vaginal pap due to a hysterectomy then you do add the V76.47 and you must add the appropriate V88.xx code to indicate the acquire absence of the uterus and or cervix which would preclude the ability to perform a cervical pap. The V88.xx codes define whether there is no cervix or a remaining cervical stump. This is information that should be available in the patients history usually in PFSH statement.

[heatherwinters]

Okay, so here is the scenario
A healthy woman comes in with no complaints for a routine GYN examination and pap smear with Medicare. She has no prior surgeries and no complaints. This would be a G0101, Q0091 and V72.31.

I am still confused about when the V76.2 and V76.47 should be used to indicate the pap. If it's part of a routine GYN examination, the V72.31 covers everything? So when do you use the other two?