Ob-Gyn Coding Alert

Question: How should I bill for a repeat Pap smear when the first Pap is sent back due to inadequate cells? The lab bills the patient directly for its service, and the practice bills the visit and specimen handling to the insurance company. I cannot find any ICD-9 code that indicates that the Pap is being redone because of inadequate cells in the first Pap. The practice now bills only the specimen-handling fee and advises patients before scheduling the repeat Pap that the service will probably be denied and they will be responsible for payment.
Wisconsin Subscriber   Answer: Per the ICD-9 Coordination and Maintenance Committee at the National Center for Health Statistics, the only correct code for a repeat Pap due to insufficient cells is V76.2 (special screening for malignant neoplasm, cervix).  
Assuming that nothing is wrong with the patient, and the repeat Pap is needed merely due to scanty cells, it is important not to use any other diagnosis code than V76.2, since the Pap itself was not abnormal. The laboratory will send some notice that the initial smear contained too few cells. Be sure to include this documentation with the claim, and code for a lower-level E/M visit, most likely a 99212. 
For more information on billing for repeat Pap smears, see the November 2000 issue of Ob-Gyn Coding Alert, "Receive the Reimbursement You Deserve by Billing Appropriately for Repeat Pap Smears."