Ob-Gyn Coding Alert

Answer: The patient who is being followed by Pap smear every six months due to a personal history of an abnormal Pap smear might be coded with the primary diagnosis code of 795.0 (nonspecific abnormal Papanicolaou smear of cervix) for the initial follow-up Pap. The following Pap smears, if they remain normal, could then be coded with V13.2, personal history of other genital system and obstetric disorders.

The secondary diagnosis code would be V76.2 (special screening for malignant neoplasms, cervix). Code V13.2 would indicate that there is a personal history of a disorder, and the secondary diagnosis indicates the screening procedure. Because many third-party carriers use only the primary diagnosis when adjudicating the claim, you should indicate that there had been a past problem that would justify the frequency of the Pap smears. The diagnosis code V76.2 is used for everyone having a screening Pap, not necessarily due to a past problem, disorder or abnormality.

Answer for You Be the Coder provided by Emily Hill, PA-C, president of Hill & Associates, a coding and compliance consulting firm based in Wilmington, N.C.