Pathology/Lab Coding Alert

The addition of "unsatisfactory smear" to 795.09 (Other nonspecific abnormal Papanicolaou smear of cervix) may make the biggest splash, but it's just one of several systematic ICD-9 changes that add specificity to cervical diagnoses. You must understand both fifth-digit coding and cervical dysplasia classification to use these new codes correctly. The codes are effective Oct. 1, but Medicare allows a grace period until Jan. 1, 2003, when labs must use them.

"The ICD-9 changes incorporate language from the Bethesda Pap smear classification system and update some references to the cervical intraepithelial neoplasia (CIN) system," says Melanie Witt, RN, CPC, MA, an independent coding educator based in Fredericksburg, Va. Witt advises familiarity with the terminology from each system, especially the nomenclature used by your lab. Report 795.0 to Fifth Digit Four new codes under 795.0 (Nonspecific abnormal Papanicolaou smear of cervix) require reporting specific cervical Pap smear findings to the fifth digit: ICD9 795.00 Nonspecific abnormal Papanicolaou smear of cervix, unspecified
795.01 Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign)
795.02 Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia)
795.09 Other nonspecific abnormal Papanicolaou smear of cervix. "These codes use Bethesda classification language to help you assign the proper ICD-9 code based on what you'll see in the pathology report," Witt explains. And you must assign the fifth digit Medicare doesn't accept "truncated codes," reported to only the third or fourth digit when a fifth is available. For example, report 795.00 rather than 795.0 for a nonspecific abnormal Pap that provides no further information. Link CIN/Bethesda New explanations appear under 622.1 (Dysplasia of cervix [uteri]) and 795.0 linking the codes to the CIN and Bethesda classification. Notes direct coders to use 622.1 for CIN I or CIN II, or high-grade squamous intraepithelial dysplasia (HGSIL) or low-grade squamous intraepithelial dysplasia (LGSIL) in the Bethesda system.

New language under 795.0 directs coders to the proper code for certain excluded conditions: carcinoma in-situ of cervix (622.1); CIN I (622.1); CIN II (622.1); CIN III (233.1); dysplasia of cervix (uteri) (622.1); HGSIL (622.1); and LGSIL (622.1). The Bethesda and CIN systems do not correspond directly, so the definitions can lead to some confusion, Witt says. A case in point is HGSIL findings, reported as 622.1, which may also appear in the pathology report as CIN III, coded as 233.1 (Carcinoma in situ of cervix uteri). "If the report lists HGSIL with no further explanation, report 622.1," Witt advises. But you should use 233.1 if the pathology report mentions both HGSIL and CIN III, she says.

Don't get too comfortable with these new codes, Witt says, because the Bethesda committee met recently and made recommendations [...]