Ob-Gyn Coding Alert

Good news: ASC-US, ASC-H, LGSIL, and HGSIL will have one-to-one matches.

When a patient's cervical Pap smear returns abnormal results, you should report 795.0x (Abnormal Papanicolaou smear of cervix and cervical HPV). This code series requires a fifth digit, and if you don't include it, this "could be a reason for a denial," says Peggy Stilley, CPC, COBGC, ACS-OB, director of auditing services at the American Academy of Professional Coders.

Here how ICD-9 defines this series:

• 795.00 -- Abnormal glandular Papanicolaou smear of cervix
• 795.01 -- Papanicolaou smear of cervix with atypical squamous cells of undetermined significance (ASC-US)
• 795.02 -- Papanicolaou smear of cervix with atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)
• 795.03 -- Papanicolaou smear of cervix with low grade squamous intraepithelial lesion (LGSIL)
• 795.04 -- Papanicolaou smear of cervix with high grade squamous intraepithelial lesion (HGSIL)
• 795.05 -- Cervical high risk human papillomavirus (HPV) DNA test positive
• 795.06 -- Papanicolaou smear of cervix with cytologic evidence of malignancy
• 795.07 -- Satisfactory cervical smear but lacking transformation zone
• 795.08 -- Unsatisfactory cervical cytology smear
• 795.09 -- Other abnormal Papanicolaou smear of cervix and cervical HPV

For example, a 35-year-old woman with multiple sexual partners presents for an annual exam. She has not had a Pap smear in four years. The Pap results return ASC-US, and the physician asks her to come back in three months for a repeat Pap to follow any abnormal cell progress. When the patient returns, you should code the appropriate E/M office visit with 795.01 because the Pap is repeated due to abnormal cells.

ICD-10: When Oct. 1 2013 turns around, you'll shift to R87.61x (Abnormal cytological findings in specimens from cervix uteri) for most of the current 795.0x codes. In this case, you'll need to add a sixth digit.

You'll break out this series as follows:

• R87.610 -- Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)
• R87.611 -- Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of cervix (ASC-H)
• R87.612 -- Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)
• R87.613 -- High grade squamous intraepithelial lesion on cytologic smear of cervix (HGSIL)
• R87.614 -- Cytologic evidence of malignancy on smear of cervix
• R87.615 -- Unsatisfactory cytologic smear of cervix
• R87.616 -- Satisfactory cervical smear but lacking transformation zone
• R87.618 -- Other abnormal cytological findings on specimens from cervix uteri
• R87.619 -- Unspecified abnormal cytological findings in specimens from cervix uteri

So, looking back at the previous example, if you're submitting a claim after Oct. 1, 2013, you would report R87.610 instead.

Here's how the correlations match up:

Note: Codes 795.05 and 795.09 do not stay within the R87.61x range. Instead, you'l report R87.810 (Cervical high risk human papillomavirus [HPV] DNA test positive) for high risk HPV and R87.820 (Cervical low risk human papillomavirus [HPV] DNA test positive) for low risk HPV.