Ob-Gyn Coding Alert

Question: The laboratory where we submit specimens insists that we should be using the V76.2 code when sending a routine Pap smear for a Medicare patient. They say, Medicare will pay for the V76.2, but they will pay nothing for the V72.3. I dont understand the difference between the two codes. It would seem that Medicare is wrongly denying payment to our patients.

G. Alan Schwemlein, MD
Cincinnati, OH

Answer: In this situation, you are technically correct. V72.3 is the correct code to use for Pap smear with a general gynecology exam. V76.2 is for a Pap smear that is obtained apart from a general gynecology exam. But heres why you are finding this confusing. Currently, Medicare carriers will only accept the V76.2 even though they are now covering some pelvic and breast screening exams, and they will not accept V72.3 regardless of what youve done. This is one of those cases where using the V76.2 for Medicare covered preventive services is not correct coding, but it is the only code Medicare will accept. Again, ACOG assures us they are working with HCFA to get this problem resolved. In the meantime, use the V76.2 and, we promise to keep you posted on any changes.