Oncology & Hematology Coding Alert

Question: What is the best way to code a follow-up visit for a patient who has completed treatment for, and no longer has evidence of, cervical cancer? Is it possible to code this as a well-woman visit?

New Hampshire Subscriber

Answer: There are different ways to code this scenario depending on the nature of the patient’s specific health status, follow-up screening plan, and insurance requirements.

If the payer is Medicare or a private carrier that follows Medicare rules, you could code this as an annual wellness visit (AWV) using HCPCS Level II codes G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit) or G0439 (Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit), assuming your patient has not already exhausted their AWV benefit with their primary care physician (PCP) or other provider. These visits include screenings for cervical cancer (see www.medicare.gov/ coverage/yearly-wellness-visits) that are usually only allowed every 24 months, though if the patient is “at high risk for cervical or vaginal cancer, or … of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months,” according to Medicare (www. medicare.gov/coverage/cervical-vaginal-cancer-screenings).

An alternative for payers that do not cover AWVs, and if the purpose of the visit is preventative in nature, would be to code a preventative visit from 99381-99397 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual …).

Remember: In these situations, you would not use ICD-10-CM code Z12.4 (Encounter for screening for malignant neoplasm of cervix) to justify the medical necessity for the screening as the screening is a part of a general gynecological exam. Instead, you would follow the Excludes1 instruction for Z12.4, which tells you to use a code from Z01.4- (Encounter for gynecological examination) instead.

An office/outpatient evaluation and management (E/M) using the appropriate code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) could also be appropriate depending on the nature of the patient’s presentation and service(s) rendered.

In this scenario, you’ll use Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) to justify the medical necessity of the follow-up. And, following the ICD-10-CM instructional note to the code, you’ll use an additional code from Z85.- (Personal history of malignant neoplasm) to identify the personal history of malignant neoplasm — in this case, Z85.41 (Personal history of malignant neoplasm of cervix uteri).